MEDICARE: MRS. YUSHU CHENG DOM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	# 592	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0292307	OTHER	NM	LOVELACE
2	NM00R494	OTHER	NM	BLUE CROSS AND BLUE SHIEL

General Provider Information

NPI Number	:	1871609032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YUSHU CHENG DOM

Provider Business Mailing Address
First Line	:	3500 TRINITY DR
Second Line	:	SUITE A-3
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-2221
Country	:	US
Telephone Number	:	505-661-4127
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 TRINITY DR
Second Line	:	SUITE A-3
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-2221
Country	:	US
Telephone Number	:	505-661-4127
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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Directions to “ MRS. YUSHU CHENG DOM” Practice Location

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