Provider Demographics
NPI:1619025988
Name:CHENG, KAE SC (DMD MD)
Entity type:Individual
Prefix:
First Name:KAE
Middle Name:SC
Last Name:CHENG
Suffix:
Gender:M
Credentials:DMD MD
Other - Prefix:
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Mailing Address - Street 1:442 SW UMATILLA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7039
Mailing Address - Country:US
Mailing Address - Phone:888-480-4478
Mailing Address - Fax:541-504-3907
Practice Address - Street 1:1740 W 17TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3619
Practice Address - Country:US
Practice Address - Phone:888-468-0022
Practice Address - Fax:541-504-3907
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORD79301223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1619025988OtherNPI