Healthcare Provider Details

I. General information

NPI: 1871965293
Provider Name (Legal Business Name): KAKI CHEUNG PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2015
Last Update Date: 12/12/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 SHATTUCK AVE
BERKELEY CA
94704-1517
US

IV. Provider business mailing address

2300 SHATTUCK AVE
BERKELEY CA
94704-1517
US

V. Phone/Fax

Practice location:
  • Phone: 510-549-4255
  • Fax:
Mailing address:
  • Phone: 510-549-4255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: