Provider Demographics
NPI:1124514179
Name:CHEUNG, ANNIE (MS, PPS)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:MS, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4396 JESSICA CIR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2102
Mailing Address - Country:US
Mailing Address - Phone:510-304-3436
Mailing Address - Fax:
Practice Address - Street 1:5200 VALPEY PARK AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-3262
Practice Address - Country:US
Practice Address - Phone:510-657-0344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2024-12-23
Deactivation Date:2024-10-10
Deactivation Code:
Reactivation Date:2024-11-01
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA230080839101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician