Provider Demographics
NPI:1801908777
Name:CHENG, IAN (DMD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:
Last Name:CHENG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-5305
Mailing Address - Country:US
Mailing Address - Phone:562-598-4477
Mailing Address - Fax:562-598-4452
Practice Address - Street 1:2914 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-5305
Practice Address - Country:US
Practice Address - Phone:562-598-4477
Practice Address - Fax:562-598-4452
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA478631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice