Individual provider Active NPI

Kae S.C. Cheng, DMD MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Eugene, OR
National Provider Identifier
1619025988
Registry record updated Oct 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
D7930 Issued in OR
Practice address
1740 W 17TH Ave
Eugene, OR 97402-3619
Phone
(888) 468-0022
Fax
(541) 504-3907
NPI assigned
Jan 5, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X D7930 OR Primary

Addresses

Primary practice location

1740 W 17TH Ave
Eugene, OR 97402-3619

Mailing address

442 SW Umatilla Ave
Suite 200
Redmond, OR 97756-7039
Phone (888) 480-4478

Other identifiers 1

IdentifierTypeStateIssuer
1619025988OtherORNPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150707002643 OR Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 1951613785

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D7930ORMDOral and Maxillofacial Surgery (Dentist)

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444262400000",
    "number": "1619025988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "442 SW UMATILLA AVE",
            "address_2": "SUITE 200",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977567039",
            "telephone_number": "888-480-4478",
            "fax_number": "541-504-3907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 W 17TH AVE",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974023619",
            "telephone_number": "888-468-0022",
            "fax_number": "541-504-3907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHENG",
        "first_name": "KAE",
        "middle_name": "S.C.",
        "credential": "DMD MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2015-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OR",
            "license": "D7930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1619025988",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eugene, OR

Sources for this page

Verify at the official NPI Registry.