Provider Demographics
NPI:1518179563
Name:CHENG, KWONG ATTILIUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:KWONG
Middle Name:ATTILIUS
Last Name:CHENG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 PARK ROW
Mailing Address - Street 2:17 D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-1149
Mailing Address - Country:US
Mailing Address - Phone:212-732-4415
Mailing Address - Fax:212-732-4415
Practice Address - Street 1:7 CHATHAM SQ
Practice Address - Street 2:SUITE 204
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-1000
Practice Address - Country:US
Practice Address - Phone:212-227-3994
Practice Address - Fax:212-227-4022
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0412221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice