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General NPI Number Information
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NPI Number | 1881893394
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Entity Type | Organization
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Legal Business Name | JAMES CHEUNG & JANA CHEN ODS A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 4141 S NOGALES ST BUILDING C UNIT 101
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City | WEST COVINA
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State | CA
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Zip | 91792-3056
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Country | US
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Telephone | 626-839-1010
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 81051
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City | SAN MARINO
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State | CA
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Zip | 91118-1051
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Country | US
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Telephone | 626-839-1010
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ SECRETARY
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Name | JAMES PAK LUN CHEUNG
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Credential | O.D.
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Telephone | 626-839-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11619T
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License Number State | CA
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