Healthcare Provider Details

I. General information

NPI: 1760598759
Provider Name (Legal Business Name): JESSIE S. CHEUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: N/A N/A MD

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 PLAINFIELD RD WILLOWBROOK
WILLOWBROOK IL
60527-7600
US

IV. Provider business mailing address

545 PLAINFIELD RD STE B
WILLOWBROOK IL
60527-7601
US

V. Phone/Fax

Practice location:
  • Phone: 630-455-0140
  • Fax:
Mailing address:
  • Phone: 630-455-0140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number239023
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number036112811
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036-112811
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: