Provider Demographics
NPI:1194759258
Name:CHENG, YAI-YUN JUDY (MD)
Entity type:Individual
Prefix:DR
First Name:YAI-YUN
Middle Name:JUDY
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 1:303 LONGMIRE RD
Mailing Address - Street 2:STE 301
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2176
Mailing Address - Country:US
Mailing Address - Phone:936-539-4449
Mailing Address - Fax:936-539-3349
Practice Address - Street 1:303 LONGMIRE RD
Practice Address - Street 2:STE 301
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2176
Practice Address - Country:US
Practice Address - Phone:936-539-4449
Practice Address - Fax:936-539-3349
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4039207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122207703Medicaid
TXG30092Medicare UPIN
TX122207703Medicaid