Provider Demographics
NPI:1639169774
Name:FENG, WALDO C (MD)
Entity Type:Individual
Prefix:DR
First Name:WALDO
Middle Name:C
Last Name:FENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:20 WADE HAMPTON TRL
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-6635
Mailing Address - Country:US
Mailing Address - Phone:702-916-1996
Mailing Address - Fax:702-916-1997
Practice Address - Street 1:3131 LA CANADA ST STE 205
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2578
Practice Address - Country:US
Practice Address - Phone:702-916-1996
Practice Address - Fax:702-916-1997
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10623174400000X
NVNV106232088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500681Medicaid
NVH74311Medicare UPIN
NV100500681Medicaid