1609296482 NPI number — CHENG AND TZENG DENTAL INC

Table of content: (NPI 1609296482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609296482 NPI number — CHENG AND TZENG DENTAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHENG AND TZENG DENTAL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609296482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 W TOWN AND COUNTRY RD
Provider Second Line Business Mailing Address:
SUITE 33
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92868-4615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-285-0505
Provider Business Mailing Address Fax Number:
714-285-0988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3662 KATELLA AVE
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
LOS ALAMITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90720-3124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-598-7914
Provider Business Practice Location Address Fax Number:
562-594-6156
Provider Enumeration Date:
04/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CHENG
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
562-598-7914

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  35860 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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