MEDICARE: DR. JASON JYH-JEN CHENG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist		IL

General Provider Information

NPI Number	:	1255509600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON JYH-JEN CHENG DDS

Provider Business Mailing Address
First Line	:	1751 W GOLF RD
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-4025
Country	:	US
Telephone Number	:	847-593-0510
Fax Number	:

Provider Business Practice Location Address
First Line	:	1751 W GOLF RD
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-4025
Country	:	US
Telephone Number	:	847-593-0510
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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