Provider Demographics
NPI:1184077828
Name:CHEUNG, RAINA (OD)
Entity type:Individual
Prefix:
First Name:RAINA
Middle Name:
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-2344
Mailing Address - Country:US
Mailing Address - Phone:626-289-6901
Mailing Address - Fax:
Practice Address - Street 1:5803 ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-1833
Practice Address - Country:US
Practice Address - Phone:626-287-8505
Practice Address - Fax:626-287-2645
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT33449TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist