Healthcare Provider Details

I. General information

NPI: 1699772756
Provider Name (Legal Business Name): RAYMOND C HEUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 02/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5222 BALBOA AVE STE 33
SAN DIEGO CA
92117-6953
US

IV. Provider business mailing address

5222 BALBOA AVE STE 33
SAN DIEGO CA
92117-6953
US

V. Phone/Fax

Practice location:
  • Phone: 858-874-8868
  • Fax: 858-874-6589
Mailing address:
  • Phone: 858-874-8868
  • Fax: 858-874-6589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA48119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: