Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | IL | |
N | 111NI0900X | Internist | IL | |
N | 207RG0300X | Geriatric Medicine | IL | |
N | 207RN0300X | Nephrologist | IL |
NPI | 1154331098 |
---|---|
Provider Name | Jen-Chieh Cheng |
First Address | Libertyville, IL 60048-3070 |
Second Address | North Chicago, IL 60064-3048 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 08/07/2007 |