Healthcare Provider Details

I. General information

NPI: 1114981958
Provider Name (Legal Business Name): EDSON H CHEUNG MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 WORTH STREET STE 720
DALLAS TX
75246
US

IV. Provider business mailing address

8111 LBJ FREEWAY STE 835
DALLAS TX
75251
US

V. Phone/Fax

Practice location:
  • Phone: 214-821-3603
  • Fax: 246-823-1317
Mailing address:
  • Phone: 972-437-2577
  • Fax: 972-644-3810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: EDSON H CHEUNG
Title or Position: PRESIDENT
Credential: MD
Phone: 214-821-3603