=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962781708
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENNIS CHEUNG PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2011
-----------------------------------------------------
Last Update Date | 11/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8695 SPECTRUM CENTER BLVD
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92123-1489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-499-4134
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 171
-----------------------------------------------------
City | DEL MAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92014-0171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-499-4134
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 53612
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------