Provider Demographics
NPI:1700841574
Name:SHEU, KUNG JENG (MD)
Entity Type:Individual
Prefix:
First Name:KUNG
Middle Name:JENG
Last Name:SHEU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18391 COLIMA RD
Mailing Address - Street 2:#207
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2730
Mailing Address - Country:US
Mailing Address - Phone:626-912-4147
Mailing Address - Fax:
Practice Address - Street 1:18391 COLIMA RD
Practice Address - Street 2:#207
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2730
Practice Address - Country:US
Practice Address - Phone:626-912-4147
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA446000173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A446000Medicaid
CA00A446000Medicaid