Provider Demographics
NPI:1194037838
Name:LEW, DERRICK CHEUNG (DPM)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:CHEUNG
Last Name:LEW
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9310 E VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770
Mailing Address - Country:US
Mailing Address - Phone:626-288-8671
Mailing Address - Fax:626-288-2498
Practice Address - Street 1:9310 E VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1924
Practice Address - Country:US
Practice Address - Phone:626-288-8671
Practice Address - Fax:626-288-2498
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEL-1851213ES0103X
CAE5066213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery