Provider Demographics
NPI:1083728414
Name:CHENG, CHIEN YUAN (DDS MD)
Entity Type:Individual
Prefix:DR
First Name:CHIEN
Middle Name:YUAN
Last Name:CHENG
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 DOMINICAN WAY
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065
Mailing Address - Country:US
Mailing Address - Phone:831-475-0221
Mailing Address - Fax:831-475-3573
Practice Address - Street 1:1663 DOMINICAN WAY
Practice Address - Street 2:SUITE 112
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065
Practice Address - Country:US
Practice Address - Phone:831-475-0221
Practice Address - Fax:831-475-3573
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2454381223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45438OtherDENTAL LICENSE
CA1298OtherANESTHESIA LICENSE
CAA88948OtherMEDICAL LICENSE
CAA88948OtherMEDICAL LICENSE
CAA88948OtherMEDICAL LICENSE