Healthcare Provider Details

I. General information

NPI: 1205099124
Provider Name (Legal Business Name): KATHERINE LOREE CHENG D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 07/08/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4494 PALMER RD N
BETHESDA MD
20814
US

IV. Provider business mailing address

7700 ARLINGTON BLVD STE 5113
FALLS CHURCH VA
22042-5190
US

V. Phone/Fax

Practice location:
  • Phone: 310-295-4000
  • Fax:
Mailing address:
  • Phone: 217-836-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019-027710
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number319.016602
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: