Provider Demographics
NPI:1851426902
Name:VIVIAN W CHENG, DMD, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:VIVIAN W CHENG, DMD, PROFESSIONAL CORPORATION
Other - Org Name:PLEASANTON VALLEY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:408-263-4443
Mailing Address - Street 1:460 E CALAVERAS BLVD
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035
Mailing Address - Country:US
Mailing Address - Phone:408-263-4443
Mailing Address - Fax:925-600-1005
Practice Address - Street 1:460 E CALAVERAS BLVD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035
Practice Address - Country:US
Practice Address - Phone:408-263-4443
Practice Address - Fax:925-600-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X, 1223G0001X
CA53506261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty