Individual
JUSTIN CHEONGSIATMOY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
24 S WEBER ST STE 200, COLORADO SPRINGS, CO 80903-1928
(424) 652-8506
Mailing address
24 S WEBER ST STE 200, COLORADO SPRINGS, CO 80903-1928
(424) 652-8506
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
A120867
CA
2084N0600X
Clinical Neurophysiology Physician
A120867
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A120867
MEDICAL LICENSE
CA
Enumeration date
01/25/2012
Last updated
02/18/2021
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