Healthcare Provider Details

I. General information

NPI: 1164862728
Provider Name (Legal Business Name): NICOLE CHEUNG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9810 LAS TUNAS DR
TEMPLE CITY CA
91780-2208
US

IV. Provider business mailing address

959 E WALNUT ST STE 122
PASADENA CA
91106-1451
US

V. Phone/Fax

Practice location:
  • Phone: 626-309-7600
  • Fax:
Mailing address:
  • Phone: 626-765-4182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A13688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: