Healthcare Provider Details

I. General information

NPI: 1730684267
Provider Name (Legal Business Name): KIANG YIEN A CHEUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 S MILDRED ST STE 102
TACOMA WA
98465-1628
US

IV. Provider business mailing address

801 SW 16TH ST STE 121
RENTON WA
98057-2628
US

V. Phone/Fax

Practice location:
  • Phone: 206-538-6300
  • Fax: 206-538-6301
Mailing address:
  • Phone: 206-538-6300
  • Fax: 206-538-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD61417375
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD61417375
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD61417375
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: