Provider Demographics
NPI:1902018344
Name:CHEUNG, SERINA PUI SHAN (DDS)
Entity Type:Individual
Prefix:
First Name:SERINA PUI
Middle Name:SHAN
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 1:114 BOWERY
Mailing Address - Street 2:2ND FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4727
Mailing Address - Country:US
Mailing Address - Phone:212-966-6968
Mailing Address - Fax:
Practice Address - Street 1:114 BOWERY
Practice Address - Street 2:2ND FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4727
Practice Address - Country:US
Practice Address - Phone:212-966-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047473122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist