MEDICARE: H. ELAINE CHEONG, D.D.S., L.L.C.

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	2000143591	MO

General Provider Information

NPI Number	:	1417067554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H. ELAINE CHEONG, D.D.S., L.L.C.

Provider Business Mailing Address
First Line	:	201 W BROADWAY
Second Line	:	BUILDING 2, SUITE A
City	:	COLUMBIA
State	:	MO
Zip	:	65203-3842
Country	:	US
Telephone Number	:	573-499-0300
Fax Number	:	573-499-9088

Provider Business Practice Location Address
First Line	:	201 W BROADWAY
Second Line	:	BUILDING 2, SUITE A
City	:	COLUMBIA
State	:	MO
Zip	:	65203-3842
Country	:	US
Telephone Number	:	573-499-0300
Fax Number	:	573-499-9088

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. HU Y. 'ELAINE' CHEONG
Credential	:	D.D.S.
Telephone Number	:	573-499-0300

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/22/2020

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