Provider Demographics
NPI:1760504864
Name:TIEN C. CHENG, MD,SC
Entity Type:Organization
Organization Name:TIEN C. CHENG, MD,SC
Other - Org Name:TIEN C. CHENG, MD,SC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-623-9700
Mailing Address - Street 1:5101 WASHINGTON ST STE 24
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2988
Mailing Address - Country:US
Mailing Address - Phone:847-623-9700
Mailing Address - Fax:847-623-9711
Practice Address - Street 1:5101 WASHINGTON ST STE 24
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2988
Practice Address - Country:US
Practice Address - Phone:847-623-9700
Practice Address - Fax:847-623-9711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047818174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD10213Medicare UPIN