Provider Demographics
NPI:1588989339
Name:CHEUNG, MIRA HUI
Entity type:Individual
Prefix:
First Name:MIRA
Middle Name:HUI
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 HICKEY BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2770
Mailing Address - Country:US
Mailing Address - Phone:650-742-2050
Mailing Address - Fax:
Practice Address - Street 1:395 HICKEY BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2770
Practice Address - Country:US
Practice Address - Phone:650-742-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036131713208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics