Provider Demographics
NPI:1174530026
Name:CHENG DDS MD INC AND WEN S FAN DMD MD INC A PARTNERSHIP
Entity type:Organization
Organization Name:CHENG DDS MD INC AND WEN S FAN DMD MD INC A PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIEN
Authorized Official - Middle Name:YVAN
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:408-298-7775
Mailing Address - Street 1:2039 FOREST AVENUE
Mailing Address - Street 2:SUITE #306
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128
Mailing Address - Country:US
Mailing Address - Phone:408-298-7775
Mailing Address - Fax:408-298-0936
Practice Address - Street 1:2039 FOREST AVENUE
Practice Address - Street 2:SUITE #306
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-298-7775
Practice Address - Fax:408-298-0936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP29361223P0106X
CA235801223S0112X
CA526031223S0112X
CA454381223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty