Healthcare Provider Details

I. General information

NPI: 1083243067
Provider Name (Legal Business Name): COREY CHEUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 11/14/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 DUBLIN BLVD FL 1
DUBLIN CA
94568-3112
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 925-875-3700
  • Fax:
Mailing address:
  • Phone: 925-875-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA187815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: