Provider Demographics
NPI:1508358755
Name:CHEUNG, XIAN (DO)
Entity Type:Individual
Prefix:
First Name:XIAN
Middle Name:
Last Name:CHEUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 108TH ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2025
Mailing Address - Country:US
Mailing Address - Phone:718-651-4000
Mailing Address - Fax:718-991-4516
Practice Address - Street 1:3716 108TH ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2025
Practice Address - Country:US
Practice Address - Phone:718-651-4000
Practice Address - Fax:718-991-4516
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT018505207Q00000X
PAO020855207Q00000X
NY307925-01207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine