Provider Demographics
NPI:1669407987
Name:CHENG, CHIN LIN (MD)
Entity type:Individual
Prefix:
First Name:CHIN
Middle Name:LIN
Last Name:CHENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 SUNCREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-1831
Mailing Address - Country:US
Mailing Address - Phone:276-466-8201
Mailing Address - Fax:276-466-8201
Practice Address - Street 1:381 SUNCREST DRIVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-1831
Practice Address - Country:US
Practice Address - Phone:276-466-8201
Practice Address - Fax:276-466-8201
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026301208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4176433OtherMEDAID TENN CARE
055998OtherANTHEM BCBS
055998OtherANTHEM BCBS