Provider Demographics
NPI:1659609477
Name:FENG, XIAODONG (PHARMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:XIAODONG
Middle Name:
Last Name:FENG
Suffix:
Gender:M
Credentials:PHARMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 IRON MOUNTAIN CT
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-7100
Mailing Address - Country:US
Mailing Address - Phone:916-473-2813
Mailing Address - Fax:916-631-8127
Practice Address - Street 1:10811 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-7368
Practice Address - Country:US
Practice Address - Phone:916-631-8108
Practice Address - Fax:916-631-8127
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA600401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA60040OtherCALIFORNIA BOARD OF PHARMACY