Provider Demographics
NPI:1497036172
Name:CHEONG, ANDREW BRIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:BRIAN
Last Name:CHEONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 BRIGHAM YOUNG DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-2064
Mailing Address - Country:US
Mailing Address - Phone:909-525-7554
Mailing Address - Fax:
Practice Address - Street 1:620 E ADELAIDE WAY
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-1616
Practice Address - Country:US
Practice Address - Phone:559-591-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX275251223G0001X
CA60524122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice