Provider Demographics
NPI:1346378403
Name:CHEUNG, SHUNG MAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHUNG
Middle Name:MAN
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8239 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-2401
Mailing Address - Country:US
Mailing Address - Phone:626-292-2229
Mailing Address - Fax:
Practice Address - Street 1:1212 PICO ST
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3503
Practice Address - Country:US
Practice Address - Phone:818-837-6940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36363208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB84767Medicare UPIN