Healthcare Provider Details

I. General information

NPI: 1205093200
Provider Name (Legal Business Name): JASON CHENG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N SANTA ROSA ST
SAN ANTONIO TX
78207-3108
US

IV. Provider business mailing address

PO BOX 12507
SAN ANTONIO TX
78212-0507
US

V. Phone/Fax

Practice location:
  • Phone: 210-704-2467
  • Fax: 903-663-7394
Mailing address:
  • Phone: 210-704-2467
  • Fax: 903-663-7394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberQ1372
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: