Basic Information
Provider Information
NPI: 1326417668
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHEUNG
FirstName: MICHAEL
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PHARMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1695 CEDARCREEK DR
Address2:  
City: SAN JOSE
State: CA
PostalCode: 951211809
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 795 WILLOW RD
Address2:  
City: MENLO PARK
State: CA
PostalCode: 940252539
CountryCode: US
TelephoneNumber: 6504935000
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/16/2015
LastUpdateDate: 01/16/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/16/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000XRPH73338CAY Pharmacy Service ProvidersPharmacist 

No ID Information.


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