Cheng Im Shao Chue Gomez PLLC

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

DE00011005 Issued in WA

Legal business name

CHENG IM SHAO CHUE GOMEZ PLLC

Doing business as

Sunrise Dental of Maple Valley

Practice address

22035 SE Wax Rd
Ste 5
Maple Valley, WA 98038-8543

Phone

(425) 432-4131

NPI assigned

Jun 11, 2016

Last updated

Jun 11, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Tanya Galiant

Title

Manager

Phone

(425) 432-4131

Specialties & licenses 1

Addresses

Other names 1

• Sunrise Dental of Maple Valley Doing business as

Locations

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

{
    "created_epoch": "1465603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465603200000",
    "number": "1932558780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22035 SE WAX RD",
            "address_2": "STE 5",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980388543",
            "telephone_number": "425-432-4131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22035 SE WAX RD",
            "address_2": "STE 5",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980388543",
            "telephone_number": "425-432-4131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHENG IM SHAO CHUE GOMEZ PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-11",
        "last_updated": "2016-06-11",
        "status": "A",
        "authorized_official_last_name": "GALIANT",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "425-432-4131",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "WA",
            "license": "DE00011005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunrise Dental of Maple Valley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer A Castelluccio, PAC
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• Ifeanyi Charles Chukwu, M.ED.
• Jillian Clifton, LMP

• Preferred Provider Organization in Maple Valley, WA
• Providers in Maple Valley, WA by specialty
• Preferred Provider Organization in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.