Healthcare Provider Details

I. General information

NPI: 1073503314
Provider Name (Legal Business Name): NAOMI B CHEUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 12/08/2021
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11420 WARNER AVE
FOUNTAIN VALLEY CA
92708-2529
US

IV. Provider business mailing address

17360 BROOKHURST ST ATTN: NETWORK MANAGEMENT
FOUNTAIN VALLEY CA
92708-3720
US

V. Phone/Fax

Practice location:
  • Phone: 714-549-1300
  • Fax: 714-433-1300
Mailing address:
  • Phone: 714-377-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA86263
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: