Organization Active NPI

Simon Cheung, a Professional Corp

  • Cardiovascular Disease Physician
  • Fountain Valley, CA
National Provider Identifier
1891875258
Registry record updated Oct 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
G87151 Issued in CA
Legal business name
SIMON CHEUNG, A PROFESSIONAL CORP
Practice address
11100 Warner Ave Ste 310
Fountain Valley, CA 92708-4009
Phone
(714) 424-0109
Fax
(714) 424-0119
NPI assigned
Oct 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Simon Cheung, M.D.NPI 1841370210
Title
President
Phone
(714) 424-0109

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X G87151 CA Primary

Addresses

Primary practice location

11100 Warner Ave Ste 310
Fountain Valley, CA 92708-4009

Mailing address

11100 Warner Ave Ste 310
Fountain Valley, CA 92708-4009
Phone (714) 424-0109

Other identifiers 2

IdentifierTypeStateIssuer
00G871510OtherCABLUE SHIELD
00G871511MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040729001585 CA Part B Supplier - Clinic/Group Practice 5799755377 Receives reassigned benefits from 1 practitioner
Practice locations: Fountain Valley, CA

National Provider Directory

National Provider Directory

Locations

17220 Newhope St
Ste 1251
Fountain Valley, CA 92708

11180 Warner Ave
Ste 363
Fountain Valley, CA 92708
Phone (714) 327-1625

11100 Warner Ave
Ste 310
Fountain Vly, CA 92708
Phone (714) 824-6560

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287014400000",
    "number": "1891875258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11100 WARNER AVE STE 310",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084009",
            "telephone_number": "714-424-0109",
            "fax_number": "714-424-0119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11100 WARNER AVE STE 310",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084009",
            "telephone_number": "714-424-0109",
            "fax_number": "714-424-0119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMON CHEUNG, A PROFESSIONAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2010-10-14",
        "status": "A",
        "authorized_official_last_name": "CHEUNG",
        "authorized_official_first_name": "SIMON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-424-0109",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "G87151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00G871510",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G871511",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.