Healthcare Provider Details

I. General information

NPI: 1346378403
Provider Name (Legal Business Name): SHUNG MAN CHEUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 PICO ST
SAN FERNANDO CA
91340-3503
US

IV. Provider business mailing address

8239 BEVERLY DR
SAN GABRIEL CA
91775-2401
US

V. Phone/Fax

Practice location:
  • Phone: 818-837-6940
  • Fax:
Mailing address:
  • Phone: 626-292-2229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA36363
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: