Provider Demographics
NPI:1366929507
Name:CHEUNG, TIFFANY KATE
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:KATE
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1194 ROYAL CREST DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-2910
Mailing Address - Country:US
Mailing Address - Phone:408-568-0138
Mailing Address - Fax:
Practice Address - Street 1:1194 ROYAL CREST DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-2910
Practice Address - Country:US
Practice Address - Phone:408-568-0138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102838122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA102838OtherDENTAL LICENSE