Provider Demographics
NPI:1497925747
Name:CHENG, LIWEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LIWEN
Middle Name:
Last Name:CHENG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ANDY
Other - Middle Name:LIWEN
Other - Last Name:CHENG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:675 CAMINO DE LOS MARES
Mailing Address - Street 2:STE 304
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2835
Mailing Address - Country:US
Mailing Address - Phone:949-496-5001
Mailing Address - Fax:949-496-0372
Practice Address - Street 1:675 CAMINO DE LOS MARES
Practice Address - Street 2:STE 304
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2835
Practice Address - Country:US
Practice Address - Phone:949-496-5001
Practice Address - Fax:949-496-0372
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist