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General NPI Number Information
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NPI Number | 1245809516
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Entity Type | Organization
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Legal Business Name | CHENG DENTAL PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/22/2021
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Last Update Date | 06/22/2021
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Provider Practice Location Address
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Address Line | 586 WASHINGTON ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94111-2929
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Country | US
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Telephone | 415-610-8835
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Fax |
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Provider Business Mailing Address
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Address Line | 220 4TH ST STE 200
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City | OAKLAND
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State | CA
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Zip | 94607-4335
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Country | US
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Telephone | 508-498-5338
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AMANDA CHENG
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Credential | DMD
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Telephone | 617-515-1846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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