Provider Demographics
NPI:1497817886
Name:CHENG, DENNIS (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:CHENG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 E VALLEY BLVD
Mailing Address - Street 2:#117
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-3195
Mailing Address - Country:US
Mailing Address - Phone:626-839-1800
Mailing Address - Fax:626-839-1802
Practice Address - Street 1:2707 E VALLEY BLVD
Practice Address - Street 2:#117
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-3195
Practice Address - Country:US
Practice Address - Phone:626-839-1800
Practice Address - Fax:626-839-1802
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9221152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA49153OtherSAFEGUARD
CASD0092211Medicaid
CA6227OtherVSP
0P9221Medicare ID - Type Unspecified