Provider Demographics
NPI:1699044065
Name:WEN S. FAN DMD, MD AND CHENG DDS, MD
Entity Type:Organization
Organization Name:WEN S. FAN DMD, MD AND CHENG DDS, MD
Other - Org Name:CUPERTINO ORAL SURGERY & DENTAL IMPLANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:408-517-0985
Mailing Address - Street 1:20530 TOWN CENTER LN
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3200
Mailing Address - Country:US
Mailing Address - Phone:408-517-0985
Mailing Address - Fax:408-517-8861
Practice Address - Street 1:20530 TOWN CENTER LN
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3200
Practice Address - Country:US
Practice Address - Phone:408-517-0985
Practice Address - Fax:408-517-8861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty