Provider Demographics
NPI:1417069386
Name:ZENG, DAFANG (OMD, LAC)
Entity Type:Individual
Prefix:
First Name:DAFANG
Middle Name:
Last Name:ZENG
Suffix:
Gender:M
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20635 VALLEY BLVD
Mailing Address - Street 2:#D
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2744
Mailing Address - Country:US
Mailing Address - Phone:909-444-9088
Mailing Address - Fax:909-595-9526
Practice Address - Street 1:20635 VALLEY BLVD
Practice Address - Street 2:#D
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2744
Practice Address - Country:US
Practice Address - Phone:909-444-9088
Practice Address - Fax:909-595-9526
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4745171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist