Provider Demographics
NPI:1194740480
Name:CHEUNG, BONNIE W (MD)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:W
Last Name:CHEUNG
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 ADRIAN CT
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-1601
Mailing Address - Country:US
Mailing Address - Phone:216-337-3670
Mailing Address - Fax:
Practice Address - Street 1:10 CONGRESS ST
Practice Address - Street 2:SUITE 511
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3045
Practice Address - Country:US
Practice Address - Phone:626-796-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76760207V00000X, 207VM0101X
OH35-084868207V00000X
MT117963207VM0101X
MO2023014725207VM0101X
TXU6462207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH221434OtherUNISON
OH7835617OtherAETNA
OH2493494Medicaid
OH000000509153OtherANTHEM
OHI13225Medicare UPIN
OH2493494Medicaid
OHCH7369041Medicare PIN
OHCH4138983Medicare PIN