Healthcare Provider Details

I. General information

NPI: 1821449190
Provider Name (Legal Business Name): HUNTINGTON PERINATAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONGRESS ST SUITE 511
PASADENA CA
91105-3045
US

IV. Provider business mailing address

10 CONGRESS ST SUITE 511
PASADENA CA
91105-3045
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-0360
  • Fax:
Mailing address:
  • Phone: 626-796-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD- A76760
License Number StateCA

VIII. Authorized Official

Name: BONNIE CHEUNG
Title or Position: PHYSICIAN
Credential: MD
Phone: 626-796-0360