Provider Demographics
NPI:1467529420
Name:CHENG, JANICE TAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:TAN
Last Name:CHENG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2603
Mailing Address - Country:US
Mailing Address - Phone:909-364-0030
Mailing Address - Fax:909-591-8779
Practice Address - Street 1:12400 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2603
Practice Address - Country:US
Practice Address - Phone:909-364-0030
Practice Address - Fax:909-591-8779
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55115122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist