Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 43524 | CA |
NPI | 1073668620 |
---|---|
Provider Name | Dr. Joseph Tzu-Shuo Cheng |
First Address | Rancho Cucamonga, CA 91730-0744 |
Second Address | Rancho Cucamonga, CA 91730-0743 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 18/06/2015 |