Provider Demographics
NPI:1104832765
Name:KENG, MOSES J (MD)
Entity Type:Individual
Prefix:
First Name:MOSES
Middle Name:J
Last Name:KENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 678459
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8459
Mailing Address - Country:US
Mailing Address - Phone:972-416-1764
Mailing Address - Fax:972-416-5890
Practice Address - Street 1:2245 MARSH LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006
Practice Address - Country:US
Practice Address - Phone:972-416-1764
Practice Address - Fax:972-416-5890
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1181208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200554801Medicaid
TX8X6400OtherBCBS
TX8F5935Medicare PIN
TX8X6400OtherBCBS
I31132Medicare UPIN