Provider Demographics
NPI:1336226398
Name:CHEUNG, DEANNA G (MD)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:G
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4772 KATELLA AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2683
Mailing Address - Country:US
Mailing Address - Phone:562-595-9366
Mailing Address - Fax:562-595-7829
Practice Address - Street 1:4772 KATELLA AVE STE 200
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2683
Practice Address - Country:US
Practice Address - Phone:562-595-9366
Practice Address - Fax:610-273-5591
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51442174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA93066Medicare UPIN
CAWG51442DMedicare ID - Type UnspecifiedMEDICARE NUMBER