Provider Demographics
NPI:1356309538
Name:CHENG, JESSE W (MD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:W
Last Name:CHENG
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 1:5555 W 58TH ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2722
Mailing Address - Country:US
Mailing Address - Phone:913-432-3780
Mailing Address - Fax:913-432-8463
Practice Address - Street 1:2040 HUTTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-4564
Practice Address - Country:US
Practice Address - Phone:913-299-3700
Practice Address - Fax:913-299-2050
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0429292207R00000X
MO36586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSF200000OtherMEDICARE GROUP NUMBER
KSF200000OtherMEDICARE GROUP NUMBER
KSF20E333Medicare PIN