Provider Demographics
NPI:1417279639
Name:KAM Y CHEUNG MD A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:KAM Y CHEUNG MD A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAM
Authorized Official - Middle Name:YUEN
Authorized Official - Last Name:CHEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-268-9888
Mailing Address - Street 1:638 WEBSTER ST STE 328
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4126
Mailing Address - Country:US
Mailing Address - Phone:510-268-9888
Mailing Address - Fax:510-268-9892
Practice Address - Street 1:638 WEBSTER ST STE 328
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4126
Practice Address - Country:US
Practice Address - Phone:510-268-9888
Practice Address - Fax:510-268-9892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49444207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A494441Medicaid
CAF01466Medicare UPIN
CA00A494441Medicaid