Provider Demographics
NPI:1699772756
Name:HEUNG, RAYMOND C (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:C
Last Name:HEUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5222 BALBOA AVE
Mailing Address - Street 2:STE 33
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6953
Mailing Address - Country:US
Mailing Address - Phone:858-874-8868
Mailing Address - Fax:858-874-6589
Practice Address - Street 1:5222 BALBOA AVE
Practice Address - Street 2:STE 33
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6953
Practice Address - Country:US
Practice Address - Phone:858-874-8868
Practice Address - Fax:858-874-6589
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2017-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA48119207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A481191Medicaid
CA00A481191Medicaid
CAA48119Medicare ID - Type Unspecified