Provider Demographics
NPI:1750842415
Name:BRIAN H. CHEUNG, DDS, MD, PLLC
Entity Type:Organization
Organization Name:BRIAN H. CHEUNG, DDS, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:HIUFAI
Authorized Official - Last Name:CHEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:206-412-8554
Mailing Address - Street 1:19623 30TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1503
Mailing Address - Country:US
Mailing Address - Phone:206-412-8554
Mailing Address - Fax:
Practice Address - Street 1:509 OLIVE WAY STE 1331
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1743
Practice Address - Country:US
Practice Address - Phone:206-624-0852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100290061Medicaid