MEDICARE: NICOLE CHEUNG DO

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	207Q00000X	Family Medicine Physician	20A13688	CA

General Provider Information

NPI Number	:	1164862728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE CHEUNG DO

Provider Business Mailing Address
First Line	:	959 E WALNUT ST STE 122
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-1451
Country	:	US
Telephone Number	:	626-765-4182
Fax Number	:

Provider Business Practice Location Address
First Line	:	1809 VERDUGO BLVD STE 200
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-1402
Country	:	US
Telephone Number	:	818-790-1616
Fax Number	:	818-790-2816

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

Provider Enumeration Date	:	06/27/2013
Last Update Date	:	01/20/2026

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