Provider Demographics
NPI:1942200464
Name:CHENG, JUNG T (MD)
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:T
Last Name:CHENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9257
Mailing Address - Country:US
Mailing Address - Phone:817-882-2400
Mailing Address - Fax:817-882-2401
Practice Address - Street 1:600 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2410
Practice Address - Country:US
Practice Address - Phone:817-882-2400
Practice Address - Fax:817-882-2401
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH61142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00613859OtherRAILROAD MEDICARE
TX046077603Medicaid
TX046077602Medicaid
TX8K7155Medicare PIN
TX046077603Medicaid