Healthcare Provider Details

I. General information

NPI: 1598392730
Provider Name (Legal Business Name): KERRY ZHU CHENG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 CAPITAL BLVD STE 101
RALEIGH NC
27604-4540
US

IV. Provider business mailing address

1001 ROCK QUARRY RD
RALEIGH NC
27610-3825
US

V. Phone/Fax

Practice location:
  • Phone: 919-833-3111
  • Fax:
Mailing address:
  • Phone: 919-833-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12914
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: