Healthcare Provider Details

I. General information

NPI: 1942782669
Provider Name (Legal Business Name): ADDISON CHI-KEE CHENG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9190 SIERRA AVE STE 101
FONTANA CA
92335-8613
US

IV. Provider business mailing address

9190 SIERRA AVE STE 101
FONTANA CA
92335-8613
US

V. Phone/Fax

Practice location:
  • Phone: 909-356-4200
  • Fax:
Mailing address:
  • Phone: 909-860-6232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number103005
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number103005
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: