Provider Demographics
NPI:1093871287
Name:CHENG, CHAUR-CHOU (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHAUR-CHOU
Middle Name:
Last Name:CHENG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4194 CONVOY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3702
Mailing Address - Country:US
Mailing Address - Phone:858-569-1918
Mailing Address - Fax:
Practice Address - Street 1:4194 CONVOY ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3702
Practice Address - Country:US
Practice Address - Phone:858-569-1918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA312271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG90694-01Medicaid