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General NPI Number Information
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NPI Number | 1396318887
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Entity Type | Organization
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Legal Business Name | CALIFORNIA NORTHSTATE UNIVERSITY
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Dates
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Enumeration Date | 07/21/2021
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 9700 WEST TARON DR.
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City | ELK GROVE
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State | CA
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Zip | 95757
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Country | US
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Telephone | 916-686-8975
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Fax |
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Provider Business Mailing Address
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Address Line | 9700 WEST TARON DR.
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City | ELK GROVE
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State | CA
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Zip | 95757
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Country | US
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Telephone | 916-686-8975
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. ALVIN CHEUNG
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Credential | PHARMD, MHSA
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Telephone | 916-686-8975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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