Provider Demographics
NPI:1326638008
Name:MOH, MICHAEL FENG (MS, RD, LD, CSCS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FENG
Last Name:MOH
Suffix:
Gender:M
Credentials:MS, RD, LD, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S GREENLEAF ST
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-7050
Mailing Address - Country:US
Mailing Address - Phone:626-318-4698
Mailing Address - Fax:
Practice Address - Street 1:800 S GREENLEAF ST
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-7050
Practice Address - Country:US
Practice Address - Phone:626-318-4698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86176133V00000X
86108227133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered