Healthcare Provider Details

I. General information

NPI: 1932587441
Provider Name (Legal Business Name): BRIAN CHEUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2015
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 TELEGRAPH AVE SUITE 202
BERKELEY CA
94705-1192
US

IV. Provider business mailing address

2850 TELEGRAPH AVE SUITE 202
BERKELEY CA
94705-1192
US

V. Phone/Fax

Practice location:
  • Phone: 510-841-6357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number11405
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number100230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: