Provider Demographics
NPI:1952714784
Name:KENG, GHAILA CHINASA (MD)
Entity Type:Individual
Prefix:
First Name:GHAILA
Middle Name:CHINASA
Last Name:KENG
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 1:1271 POPLAR AVE
Mailing Address - Street 2:APT 210
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-7245
Mailing Address - Country:US
Mailing Address - Phone:901-422-8642
Mailing Address - Fax:
Practice Address - Street 1:100 MERCY WAY
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4524
Practice Address - Country:US
Practice Address - Phone:417-781-4404
Practice Address - Fax:417-781-5845
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV207R00000X
OH35.133010207R00000X
MO2019033224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine