Provider Demographics
NPI:1255305447
Name:CHEUNG, EDDIE C (MD)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:C
Last Name:CHEUNG
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 1:388 9TH ST STE 218
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4293
Mailing Address - Country:US
Mailing Address - Phone:510-654-5555
Mailing Address - Fax:
Practice Address - Street 1:388 9TH ST STE 218
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4293
Practice Address - Country:US
Practice Address - Phone:510-654-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC40226207RI0008X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1255305447Medicaid
CA00C402260Medicaid
CAC40226OtherSTATE MEDICAL LICENSE
CA00C402260Medicare PIN
CAA37335Medicare UPIN
CA00C402260Medicaid
CA1255305447Medicare PIN
CAZZZ24205ZMedicare ID - Type Unspecified
CA00C402260Medicare ID - Type Unspecified
CA00C402260Medicaid