Provider Demographics
NPI:1588020655
Name:CHEUNG, LUNA
Entity Type:Individual
Prefix:
First Name:LUNA
Middle Name:
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3646 BELLAGIO CT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-7633
Mailing Address - Country:US
Mailing Address - Phone:707-494-7272
Mailing Address - Fax:
Practice Address - Street 1:3646 BELLAGIO CT
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-7633
Practice Address - Country:US
Practice Address - Phone:707-494-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist