Provider Demographics
NPI:1962500223
Name:WAN, CHEUNG SING (MD)
Entity Type:Individual
Prefix:
First Name:CHEUNG
Middle Name:SING
Last Name:WAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:121 SOUTH 7TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311
Mailing Address - Country:US
Mailing Address - Phone:760-256-8791
Mailing Address - Fax:760-256-8710
Practice Address - Street 1:121 SOUTH 7TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311
Practice Address - Country:US
Practice Address - Phone:760-256-8791
Practice Address - Fax:760-256-8710
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA34199207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA00341990Medicaid
CAA34199Medicare ID - Type Unspecified
CAA00341990Medicaid
CA0743030001Medicare NSC