Healthcare Provider Details

I. General information

NPI: 1124514179
Provider Name (Legal Business Name): ANNIE CHEUNG MS, PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date: 10/10/2024
Reactivation Date: 11/01/2024

III. Provider practice location address

5200 VALPEY PARK AVE
FREMONT CA
94538-3262
US

IV. Provider business mailing address

4396 JESSICA CIR
FREMONT CA
94555-2102
US

V. Phone/Fax

Practice location:
  • Phone: 510-657-0344
  • Fax:
Mailing address:
  • Phone: 510-304-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number230080839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: