Provider Demographics
NPI:1629176219
Name:CHENG, JIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JIE
Middle Name:
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 1:6624 FANNIN ST
Mailing Address - Street 2:SUITE 1710
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2312
Mailing Address - Country:US
Mailing Address - Phone:713-541-9955
Mailing Address - Fax:713-541-9988
Practice Address - Street 1:6624 FANNIN ST
Practice Address - Street 2:SUITE 1710
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2312
Practice Address - Country:US
Practice Address - Phone:713-541-9955
Practice Address - Fax:713-541-9988
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5279207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157867602Medicaid
TXP00306468OtherRAILROAD MEDICARE
TX8B7669Medicare ID - Type Unspecified
TXP00306468OtherRAILROAD MEDICARE