MEDICARE: ANDREW CU-UNJIENG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	C52115	CA

General Provider Information

NPI Number	:	1164421400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW CU-UNJIENG M.D.

Provider Business Mailing Address
First Line	:	3651 ARIZONA ST.
Second Line	:	#6
City	:	SAN DIEGO
State	:	CA
Zip	:	92104
Country	:	US
Telephone Number	:	619-294-6818
Fax Number	:

Provider Business Practice Location Address
First Line	:	4060 FOURTH AVE.
Second Line	:	SUITE 405
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2121
Country	:	US
Telephone Number	:	619-297-9131
Fax Number	:	619-297-6375

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	08/20/2012

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