Provider Demographics
NPI:1952629297
Name:CHEUNG, CLEMENT MANTIN
Entity Type:Individual
Prefix:MR
First Name:CLEMENT
Middle Name:MANTIN
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:PO BOX 730334
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95173-0334
Mailing Address - Country:US
Mailing Address - Phone:404-270-7889
Mailing Address - Fax:408-270-7889
Practice Address - Street 1:1698 S WOLFE RD STE 208
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-4869
Practice Address - Country:US
Practice Address - Phone:408-826-2077
Practice Address - Fax:408-737-1010
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13529171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist