1497846752 NPI number — CHEUKHUNG A NG DDS

Table of content: CHEUKHUNG A NG DDS (NPI 1497846752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497846752 NPI number — CHEUKHUNG A NG DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NG
Provider First Name:
CHEUKHUNG
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1497846752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 E 1ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALICE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78332-4822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-396-0370
Provider Business Mailing Address Fax Number:
361-664-2248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 FLOURNOY RD
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
ALICE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-664-1417
Provider Business Practice Location Address Fax Number:
185-535-0561
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  15197 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 009033401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 133270208 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: D15197 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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