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Provider Information for 1568779510



DR. CHAN WOOK CHEONG D.M.D.

Gender: MALE

Individual NPI: 1568779510

Calendar Last Updated: 2010-09-10

Details

Name Value
NPI 1568779510
Enumeration Date 2010-09-10
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 150 BROOKLINE AVE UNIT 206
BOSTON, MA 02215-3931
United States

Phone: 617-901-0693 | Fax:
View Map External Link
Primary Practice Address 188 LONGWOOD AVE
BOSTON, MA 02115-5819
United States

Phone: 617-432-1434 | Fax:
View Map External Link
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223P0700X - Dentist Prosthodontics MA DN1855564
Other Identifiers
Issuer State Number
Endpoint Information
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location