# CHENG DDS MD INC AND WEN S FAN DMD MD INC A PARTNERSHIP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Maxillofacial Surgery Center of San Jose
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174530026
- **Authorized official:** DR. CHIEN YVAN CHENG DDS, MD (OWNER/PARTNER)
- **Authorized official phone:** (408) 298-7775

## Contact information

- **Practice address:** 2039 FOREST AVENUE, SUITE \#306, SAN JOSE, CA 95128
- **Practice address phone:** (408) 298-7775
- **Practice address fax:** (408) 298-0936
- **Mailing address:** 2039 FOREST AVENUE, SUITE \#306, SAN JOSE, CA 95128
- **Mailing address phone:** (408) 298-7775
- **Mailing address fax:** (408) 298-0936

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | FNP2936 | CA | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 23580 | CA | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 45438 | CA | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 52603 | CA | — |

## Other

- **Enumeration date:** 08/02/2006
- **Last updated:** 04/04/2011