Healthcare Provider Details

I. General information

NPI: 1083006043
Provider Name (Legal Business Name): CHEUNG DPM PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2015
Last Update Date: 02/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1778 GRAND AVE
SAN DIEGO CA
92109-4414
US

IV. Provider business mailing address

1778 GRAND AVE
SAN DIEGO CA
92109-4414
US

V. Phone/Fax

Practice location:
  • Phone: 858-272-5910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEVEN CHEUNG
Title or Position: PRESIDENT
Credential: DPM
Phone: 858-272-5910