Provider Demographics
NPI:1427059195
Name:CHENG, THANH C (MD)
Entity type:Individual
Prefix:
First Name:THANH
Middle Name:C
Last Name:CHENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4219 KILLIAN CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3189
Mailing Address - Country:US
Mailing Address - Phone:281-725-0193
Mailing Address - Fax:
Practice Address - Street 1:2752 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-4601
Practice Address - Country:US
Practice Address - Phone:713-766-1096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5861207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113368802Medicaid
TXG83630Medicare UPIN
TX113368802Medicaid