Provider Demographics
NPI:1205240785
Name:CHENG, NICOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:CHENG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:YEE
Other - Middle Name:PING
Other - Last Name:HUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:10700 SANTA MONICA BLVD
Mailing Address - Street 2:STE 140
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4768
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10700 SANTA MONICA BLVD
Practice Address - Street 2:STE 140
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4768
Practice Address - Country:US
Practice Address - Phone:310-470-6121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA631751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics