Provider Demographics
NPI:1942782669
Name:CHENG, ADDISON CHI-KEE (DDS)
Entity Type:Individual
Prefix:
First Name:ADDISON
Middle Name:CHI-KEE
Last Name:CHENG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9190 SIERRA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-8613
Mailing Address - Country:US
Mailing Address - Phone:909-860-6232
Mailing Address - Fax:
Practice Address - Street 1:9190 SIERRA AVE STE 101
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-8613
Practice Address - Country:US
Practice Address - Phone:909-356-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1030051223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice