Provider Demographics
NPI:1689317091
Name:CHEUNG, BENNY JUN BEN
Entity Type:Individual
Prefix:
First Name:BENNY
Middle Name:JUN BEN
Last Name:CHEUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 PARIS ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-2060
Mailing Address - Country:US
Mailing Address - Phone:415-992-1370
Mailing Address - Fax:
Practice Address - Street 1:402 DEWEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1425
Practice Address - Country:US
Practice Address - Phone:415-242-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT301814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist