Provider Demographics
NPI:1689648685
Name:FENG, ADRIAN H (MD)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:H
Last Name:FENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 E OSBORN RD
Mailing Address - Street 2:SUITE B150
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5678
Mailing Address - Country:US
Mailing Address - Phone:602-264-4431
Mailing Address - Fax:602-241-5109
Practice Address - Street 1:1313 E OSBORN RD
Practice Address - Street 2:SUITE B150
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5678
Practice Address - Country:US
Practice Address - Phone:602-264-4431
Practice Address - Fax:602-241-5109
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31120208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ776536Medicaid
AZZ128986Medicare UPIN
73368Medicare ID - Type Unspecified
AZ776536Medicaid