Provider Demographics
NPI:1760598759
Name:CHEUNG, JESSIE S (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:S
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:545 PLAINFIELD RD STE B
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7601
Mailing Address - Country:US
Mailing Address - Phone:630-455-0140
Mailing Address - Fax:
Practice Address - Street 1:545 PLAINFIELD RD
Practice Address - Street 2:WILLOWBROOK
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7600
Practice Address - Country:US
Practice Address - Phone:630-455-0140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239023207N00000X
IL036112811207NS0135X
IL036-112811207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL267870003Medicare PIN
NY2FDD71Medicare PIN