Provider Demographics
NPI:1497846752
Name:NG, CHEUKHUNG A (DDS)
Entity Type:Individual
Prefix:
First Name:CHEUKHUNG
Middle Name:A
Last Name:NG
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 1:204 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4822
Mailing Address - Country:US
Mailing Address - Phone:361-396-0370
Mailing Address - Fax:361-664-2248
Practice Address - Street 1:700 FLOURNOY RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332
Practice Address - Country:US
Practice Address - Phone:361-664-1417
Practice Address - Fax:185-535-0561
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15197122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009033401Medicaid
TX133270208Medicaid
TXD15197OtherBLUE CROSS BLUE SHIELD
TX741679824OtherTAX ID NUMBER FOR COMMUNITY ACTION CORPORATION OF SOUTH TEXAS