1902302573 NPI number — KRISTI MICHELE CHEUNG OD

Table of content: KRISTI MICHELE CHEUNG OD (NPI 1902302573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902302573 NPI number — KRISTI MICHELE CHEUNG OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHEUNG
Provider First Name:
KRISTI
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEW
Provider Other First Name:
KRISTI
Provider Other Middle Name:
MICHELE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902302573
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3801 MIRANDA AVE
Provider Second Line Business Mailing Address:
BUILDING 5, 1ST FLOOR OPTOMETRY, OPTOM 112
Provider Business Mailing Address City Name:
PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94304-3672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-251-3103
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 MIRANDA AVE BLDG 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALO ALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94304-1207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-493-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  34061 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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