Healthcare Provider Details

I. General information

NPI: 1083807382
Provider Name (Legal Business Name): CUA & GAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 W MERCED AVE STE 114
WEST COVINA CA
91790-3402
US

IV. Provider business mailing address

1433 W MERCED AVE STE 114
WEST COVINA CA
91790-3402
US

V. Phone/Fax

Practice location:
  • Phone: 626-960-4989
  • Fax:
Mailing address:
  • Phone: 626-960-4989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA36509
License Number StateCA

VIII. Authorized Official

Name: DR. SEUNG SUE CUA
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 626-960-4989