Provider Demographics
NPI:1932558780
Name:CHENG IM SHAO CHUE GOMEZ PLLC
Entity Type:Organization
Organization Name:CHENG IM SHAO CHUE GOMEZ PLLC
Other - Org Name:SUNRISE DENTAL OF MAPLE VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALIANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-432-4131
Mailing Address - Street 1:22035 SE WAX RD
Mailing Address - Street 2:STE 5
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-8543
Mailing Address - Country:US
Mailing Address - Phone:425-432-4131
Mailing Address - Fax:
Practice Address - Street 1:22035 SE WAX RD
Practice Address - Street 2:STE 5
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8543
Practice Address - Country:US
Practice Address - Phone:425-432-4131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-11
Last Update Date:2016-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00011005305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization