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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
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223P0700X - Dentist Prosthodontics MA DN1855564