Healthcare Provider Details

I. General information

NPI: 1780524702
Provider Name (Legal Business Name): KEVIN CHEUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VAN NESS AVE
SAN FRANCISCO CA
94109-6919
US

IV. Provider business mailing address

1101 VAN NESS AVE
SAN FRANCISCO CA
94109-6919
US

V. Phone/Fax

Practice location:
  • Phone: 408-250-8574
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH81219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: