Provider Demographics
NPI:1760981492
Name:FENG, HAODA
Entity Type:Individual
Prefix:
First Name:HAODA
Middle Name:
Last Name:FENG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RM0102 BLDG 517 UNIT 2
Mailing Address - Street 2:GUANGSHUNBEIDAJIE NO33
Mailing Address - City:BEIJING
Mailing Address - State:BEIJING
Mailing Address - Zip Code:100102
Mailing Address - Country:CN
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1668 SW FELLOWS ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-5785
Practice Address - Country:US
Practice Address - Phone:206-954-4866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA3579122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer