Provider Demographics
NPI:1780790550
Name:CHENG, JENNIFER K (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:CHENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-6529
Mailing Address - Country:US
Mailing Address - Phone:617-355-5227
Mailing Address - Fax:
Practice Address - Street 1:CHILDRENS HOSPITAL
Practice Address - Street 2:300 LONGWOOD AVE.
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5737
Practice Address - Country:US
Practice Address - Phone:617-355-5227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229290208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics