Basic Information
| Provider Information | |||||||||
| NPI: | 1730105040 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHENG | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CHENG | ||||||||
| OtherFirstName: | CHRISTINE | ||||||||
| OtherMiddleName: | CHO-JEN | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2401 GILLHAM RD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641084619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162343000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2401 GILLHAM RD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641084619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162343000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 09/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | 103732 | MO | N | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | 2082S0105X | 103732 | MO | Y | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand | 2086S0122X | 04-32547 | KS | N | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | 2082S0105X | 04-32547 | KS | N | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand |
ID Information
| ID | Type | State | Issuer | Description | 38579014 | 01 | KS | BCBSKC | OTHER | 7632001 | 01 | AETNA | OTHER |