MEDICARE: JOHN CHENG DMD PLLC

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	1223G0001X	General Practice Dentistry	DE60056985	WA

General Provider Information

NPI Number	:	1346634300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN CHENG DMD PLLC

Provider Business Mailing Address
First Line	:	3340 NE 125TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-8911
Country	:	US
Telephone Number	:	206-363-6868
Fax Number	:

Provider Business Practice Location Address
First Line	:	3340 NE 125TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-8911
Country	:	US
Telephone Number	:	206-363-6868
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN CHENG
Credential	:	DMD
Telephone Number	:	206-363-6868

Provider Enumeration Date	:	03/26/2015
Last Update Date	:	03/26/2015

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