Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 57417 | CA |
NPI | 1114218153 |
---|---|
Provider Name | Joyce Yi-Tzy Cheng |
First Address | San Francisco, CA 94122-2719 |
Second Address | San Francisco, CA 94122-2719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2011 |
Last Update Date | 25/04/2011 |