Healthcare Provider Details

I. General information

NPI: 1427129337
Provider Name (Legal Business Name): THOMAS X. CUYEGKENG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E VALENCIA MESA DR STE 311
FULLERTON CA
92835-3800
US

IV. Provider business mailing address

100 E VALENCIA MESA DR STE 311
FULLERTON CA
92835-3800
US

V. Phone/Fax

Practice location:
  • Phone: 714-446-5590
  • Fax: 714-446-5592
Mailing address:
  • Phone: 714-446-5590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA53949
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberA53949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: