Provider Demographics
NPI:1154305613
Name:CHEUNG, CHI P (MD)
Entity Type:Individual
Prefix:
First Name:CHI
Middle Name:P
Last Name:CHEUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2601
Mailing Address - Country:US
Mailing Address - Phone:718-627-9080
Mailing Address - Fax:718-983-8268
Practice Address - Street 1:3080 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2601
Practice Address - Country:US
Practice Address - Phone:718-627-9080
Practice Address - Fax:718-983-8268
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1213991207R00000X, 207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00384996Medicaid
C05245Medicare UPIN
NY08A061Medicare Oscar/Certification