Provider Demographics
NPI:1073011565
Name:CHEONG, SIMON SEIHOON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:SEIHOON
Last Name:CHEONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ESTRELLA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-8109
Mailing Address - Country:US
Mailing Address - Phone:310-892-3810
Mailing Address - Fax:
Practice Address - Street 1:2105 BEVERLY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2248
Practice Address - Country:US
Practice Address - Phone:213-484-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist