MEDICARE: JESSICA MEGAN CHEN MING MD

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	208800000X	Urology Physician	MD2017-0217	NM
2	2088P0231X	Pediatric Urology Physician	MD2017-0217	NM

General Provider Information

NPI Number	:	1174849210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MEGAN CHEN MING MD

Provider Business Mailing Address
First Line	:	800 BRADBURY DR SE STE 116
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4310
Country	:	US
Telephone Number	:	505-272-1476
Fax Number	:

Provider Business Practice Location Address
First Line	:	1004 COLUMBIA DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-2627
Country	:	US
Telephone Number	:	617-645-0313
Fax Number	:

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

Provider Enumeration Date	:	04/14/2010
Last Update Date	:	09/26/2024

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