Provider Demographics
NPI:1881893394
Name:JAMES CHEUNG & JANA CHEN ODS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JAMES CHEUNG & JANA CHEN ODS A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PAK LUN
Authorized Official - Last Name:CHEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-839-1010
Mailing Address - Street 1:PO BOX 81051
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91118-1051
Mailing Address - Country:US
Mailing Address - Phone:626-839-1010
Mailing Address - Fax:
Practice Address - Street 1:4141 S NOGALES ST
Practice Address - Street 2:BUILDING C UNIT 101
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-3056
Practice Address - Country:US
Practice Address - Phone:626-839-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11619T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21137Medicare PIN