Provider Demographics
NPI:1760904593
Name:TENG MEDICAL FOUNDATION PC
Entity Type:Organization
Organization Name:TENG MEDICAL FOUNDATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHUNWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TENG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:916-253-9898
Mailing Address - Street 1:PO BOX 434
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-0434
Mailing Address - Country:US
Mailing Address - Phone:916-253-9898
Mailing Address - Fax:
Practice Address - Street 1:831 STERLING PKWY STE 110
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-7323
Practice Address - Country:US
Practice Address - Phone:916-253-9898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty