Provider Demographics
NPI:1508021544
Name:CHENG, JEDSIAN (MD/MPH)
Entity Type:Individual
Prefix:DR
First Name:JEDSIAN
Middle Name:
Last Name:CHENG
Suffix:
Gender:M
Credentials:MD/MPH
Other - Prefix:DR
Other - First Name:JED-SIAN
Other - Middle Name:
Other - Last Name:CHENG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD/MPH
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:GRB 1102
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-726-8078
Mailing Address - Fax:617-726-6131
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:GRB 1102
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-8078
Practice Address - Fax:617-726-6131
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036144098208800000X
MA255303208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036144098OtherSTATE LICENSE