Provider Demographics
NPI:1023362605
Name:CHEUNG, BETTY KWAI PING (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MISS
First Name:BETTY
Middle Name:KWAI PING
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 S SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-2743
Mailing Address - Country:US
Mailing Address - Phone:626-286-8700
Mailing Address - Fax:626-286-8650
Practice Address - Street 1:923 S SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-2743
Practice Address - Country:US
Practice Address - Phone:626-286-8700
Practice Address - Fax:626-286-8650
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1033390273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM71178FMedicaid
CA1033390273OtherNPI
CACY362AMedicaid