Provider Demographics
NPI:1386781383
Name:SO, KIN CHEONG (DDS)
Entity type:Individual
Prefix:DR
First Name:KIN
Middle Name:CHEONG
Last Name:SO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17220 140TH AVE SE
Mailing Address - Street 2:SUITE D
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-7000
Mailing Address - Country:US
Mailing Address - Phone:425-228-6080
Mailing Address - Fax:
Practice Address - Street 1:17220 140TH AVE SE
Practice Address - Street 2:SUITE D
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-7000
Practice Address - Country:US
Practice Address - Phone:425-228-6080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA051031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice