Provider Demographics
NPI:1487824769
Name:CHENG, JONATHAN C (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:C
Last Name:CHENG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:CHI
Other - Middle Name:HONG
Other - Last Name:CHENG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:2255 E MOSSY OAKS RD STE 500
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-1813
Mailing Address - Country:US
Mailing Address - Phone:626-757-9366
Mailing Address - Fax:281-440-5300
Practice Address - Street 1:1626 W BAKER RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2271
Practice Address - Country:US
Practice Address - Phone:281-837-7600
Practice Address - Fax:281-837-7611
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN56192085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1396836359OtherNPI
TX1437383908OtherNPI
TX1477553477OtherNPI
TX1871594424OtherNPI
TX1912220849OtherNPI
TX1477553477OtherNPI
TXOOK41DMedicare PIN
TX1871594424OtherNPI
TX00250TMedicare PIN
TXOA3684Medicare PIN