Provider Demographics
NPI:1912053208
Name:CHEUNG, SIMON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:CHEUNG
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 1:199-28 24TH RD
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-4130
Mailing Address - Country:US
Mailing Address - Phone:718-206-6290
Mailing Address - Fax:
Practice Address - Street 1:470 PATCHOGUE-HOLBROOK ROAD
Practice Address - Street 2:SUITE #2
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1637
Practice Address - Country:US
Practice Address - Phone:631-589-8485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0530081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice