Healthcare Provider Details

I. General information

NPI: 1932668928
Provider Name (Legal Business Name): TELLY CHEUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 4TH ST
SAN FRANCISCO CA
94143-2351
US

IV. Provider business mailing address

550 16TH ST FL 4
SAN FRANCISCO CA
94158-2545
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-3000
  • Fax:
Mailing address:
  • Phone: 415-632-8460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberA177178
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: