Healthcare Provider Details

I. General information

NPI: 1477990042
Provider Name (Legal Business Name): HUANG KEVIN CHENG DDS DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5866 MOWRY SCHOOL RD
NEWARK CA
94560-5367
US

IV. Provider business mailing address

5866 MOWRY SCHOOL RD
NEWARK CA
94560-5367
US

V. Phone/Fax

Practice location:
  • Phone: 408-438-8893
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number60523
License Number StateCA

VIII. Authorized Official

Name: DR. HUANG KEVIN CHENG
Title or Position: CEO/PRESIDENT
Credential:
Phone: 408-438-8893