Provider Demographics
NPI:1245388537
Name:RAYMOND W. M. CHEUNG, M. D., A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RAYMOND W. M. CHEUNG, M. D., A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:W M
Authorized Official - Last Name:CHEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:626-282-8387
Mailing Address - Street 1:1048 S GARFIELD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4768
Mailing Address - Country:US
Mailing Address - Phone:626-282-8387
Mailing Address - Fax:626-282-8392
Practice Address - Street 1:1048 S GARFIELD AVE STE 201
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4768
Practice Address - Country:US
Practice Address - Phone:626-282-8387
Practice Address - Fax:626-282-8392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60008207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16575Medicare ID - Type Unspecified