Healthcare Provider Details

I. General information

NPI: 1770080814
Provider Name (Legal Business Name): ANN CHEUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

100 EXCHANGE ST APT 323
MALDEN MA
02148-5518
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-9040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number287862
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: