Provider Demographics
NPI:1811999691
Name:CHEUNG, KAKEUNG CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:KAKEUNG
Middle Name:CHARLES
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 1:304 S MOUNT AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4920
Mailing Address - Country:US
Mailing Address - Phone:573-334-9933
Mailing Address - Fax:573-334-9958
Practice Address - Street 1:304 S MOUNT AUBURN RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4920
Practice Address - Country:US
Practice Address - Phone:573-334-9933
Practice Address - Fax:573-334-9958
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4E58174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF24381Medicare UPIN