Provider Demographics
NPI:1477946606
Name:CHENG, SUSANNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSANNA
Middle Name:
Last Name:CHENG
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 1:181 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3824
Mailing Address - Country:US
Mailing Address - Phone:650-343-3220
Mailing Address - Fax:650-343-7464
Practice Address - Street 1:181 2ND AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3824
Practice Address - Country:US
Practice Address - Phone:650-343-3220
Practice Address - Fax:650-343-7464
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39616122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist