Provider Demographics
NPI:1578782397
Name:CHENG, HSUEH LI (DDS)
Entity Type:Individual
Prefix:
First Name:HSUEH
Middle Name:LI
Last Name:CHENG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 S NOGALES STREET
Mailing Address - Street 2:101
Mailing Address - City:ROWLAND HTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748
Mailing Address - Country:US
Mailing Address - Phone:626-965-6723
Mailing Address - Fax:626-765-4143
Practice Address - Street 1:1015 S NOGALES STREET
Practice Address - Street 2:101
Practice Address - City:ROWLAND HTS
Practice Address - State:CA
Practice Address - Zip Code:91748
Practice Address - Country:US
Practice Address - Phone:626-965-6723
Practice Address - Fax:626-765-4143
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA352341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG90484Medicaid