Provider Demographics
NPI:1073684395
Name:CHENG, KENNETH PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:PAUL
Last Name:CHENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 BRADFORD ROAD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090
Mailing Address - Country:US
Mailing Address - Phone:724-934-3333
Mailing Address - Fax:724-934-3371
Practice Address - Street 1:100 BRADFORD ROAD
Practice Address - Street 2:SUITE 320
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090
Practice Address - Country:US
Practice Address - Phone:724-934-3333
Practice Address - Fax:724-934-3371
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034125-E207W00000X, 207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000003056OtherBC BS
PA1002364OtherGATEWAY
PA100349OtherUPMC FOR YOU
PA1172353-0003OtherCIGNA
PA0011574060004Medicaid
PA0078074OtherAETNA
PA178467OtherBC BS TRADITIONAL
PA185020001OtherUPMC
PA63252OtherUNISON
PAE12963Medicare UPIN
PA000003056OtherBC BS