Provider Demographics
NPI:1780644153
Name:CHEUNG, JENNY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:S
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43350 JUNIPER GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-1969
Mailing Address - Country:US
Mailing Address - Phone:443-691-2938
Mailing Address - Fax:
Practice Address - Street 1:9003 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5410
Practice Address - Country:US
Practice Address - Phone:703-369-2323
Practice Address - Fax:703-369-4854
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136971223G0001X
VA04014114121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice