Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 11623 | NC |
N | 1223G0001X | General Practice | 31150 | TX |
N | 213EG0000X | General Practice | 31150 | TX |
NPI | 1306201884 |
---|---|
Provider Name | Lida Cheng |
First Address | Sugar Land, TX 77479-5780 |
Second Address | Burlington, NC 27217-2954 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2015 |
Last Update Date | 15/10/2019 |