Provider Demographics
NPI:1083788434
Name:CHEONG, CHRISTINE KODNIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:KODNIM
Last Name:CHEONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 GRAND CANYON PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1739
Mailing Address - Country:US
Mailing Address - Phone:847-885-9954
Mailing Address - Fax:847-885-8633
Practice Address - Street 1:990 GRAND CANYON PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1739
Practice Address - Country:US
Practice Address - Phone:847-885-9954
Practice Address - Fax:847-885-8633
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0274591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice