Basic Information
| Provider Information | |||||||||
| NPI: | 1417944943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHENG | ||||||||
| FirstName: | MINGFANG | ||||||||
| MiddleName: | ANNIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5304 MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | BELLAIRE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774014809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138823873 | ||||||||
| FaxNumber: | 7136676102 | ||||||||
| Practice Location | |||||||||
| Address1: | 925 N SHEPHERD DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770086526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134867200 | ||||||||
| FaxNumber: | 7134867201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 07/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | L6012 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 187296201 | 05 | TX | MEDICAID | 0020PJ | 01 | TX | BCBSTX | OTHER | 159736105 | 05 | TX | MEDICAID |