Healthcare Provider Details

I. General information

NPI: 1922203991
Provider Name (Legal Business Name): LESLIE CHENG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 SCHILLER
ELMHURST IL
60126-2885
US

IV. Provider business mailing address

172 SCHILLER
ELMHURST IL
60126-2885
US

V. Phone/Fax

Practice location:
  • Phone: 630-758-5903
  • Fax: 630-758-5201
Mailing address:
  • Phone: 630-993-5676
  • Fax: 630-758-9940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36052955
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: