Provider Demographics
NPI:1073547485
Name:FENG, ALEX (LAC)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:FENG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-4229
Mailing Address - Country:US
Mailing Address - Phone:510-579-4683
Mailing Address - Fax:415-217-4198
Practice Address - Street 1:1800 31ST AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-4229
Practice Address - Country:US
Practice Address - Phone:415-677-2388
Practice Address - Fax:415-217-4198
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA297OtherSTATE ACUPUNCTURE LICENSE