=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861577611
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WINNIE W CHEUNG D.M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 COLLEGE HWY
-----------------------------------------------------
City | SOUTHWICK
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01077-9813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-569-1118
-----------------------------------------------------
Fax | 413-569-2088
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1515
-----------------------------------------------------
City | SOUTHWICK
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01077-1515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-569-1118
-----------------------------------------------------
Fax | 412-569-2088
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 19969
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------