Healthcare Provider Details

I. General information

NPI: 1851659221
Provider Name (Legal Business Name): ANDY CHENG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 05/07/2024
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 YAKIMA AVE STE 205
TACOMA WA
98405-5300
US

IV. Provider business mailing address

1708 YAKIMA AVE STE 205
TACOMA WA
98405-5300
US

V. Phone/Fax

Practice location:
  • Phone: 253-565-6777
  • Fax: 360-377-1558
Mailing address:
  • Phone: 253-565-6777
  • Fax: 360-377-1558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number64115-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD60717039
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: