Healthcare Provider Details

I. General information

NPI: 1982937629
Provider Name (Legal Business Name): JIMMY S CHEUNG JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 SUNFLOWER STREET
REDLANDS CA
92373
US

IV. Provider business mailing address

79 SUNFLOWER STREET
REDLANDS CA
92373
US

V. Phone/Fax

Practice location:
  • Phone: 951-294-7197
  • Fax:
Mailing address:
  • Phone: 951-294-7197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number58794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: