MEDICARE: CHEUNG PROFESSIONAL DENTAL CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	33734	CA

General Provider Information

NPI Number	:	1326145509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHEUNG PROFESSIONAL DENTAL CORP.

Provider Business Mailing Address
First Line	:	1283 22ND AVE. 2ND FLOOR
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-1601
Country	:	US
Telephone Number	:	415-753-9888
Fax Number	:	415-753-9688

Provider Business Practice Location Address
First Line	:	1283 22ND AVE. 2ND FLOOR
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-1601
Country	:	US
Telephone Number	:	415-753-9888
Fax Number	:	415-753-9688

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PATRICK H CHEUNG
Credential	:	D.D.S.
Telephone Number	:	415-399-8888

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	06/15/2023

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