Provider Demographics
NPI:1992746010
Name:CHEUNG, TUNG (PA)
Entity type:Individual
Prefix:
First Name:TUNG
Middle Name:
Last Name:CHEUNG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660519
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-0519
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:328 S 1ST ST
Practice Address - Street 2:SUITE H
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3707
Practice Address - Country:US
Practice Address - Phone:626-281-1903
Practice Address - Fax:626-281-4536
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13660363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA13660OtherPA LISCENSE
CAPA13660Medicaid
CAPA13660OtherPA LISCENSE