Provider Demographics
NPI:1255997417
Name:ZHENG, DEFENG (DAOM)
Entity type:Individual
Prefix:
First Name:DEFENG
Middle Name:
Last Name:ZHENG
Suffix:
Gender:M
Credentials:DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 VANDERBILT AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-5056
Mailing Address - Country:US
Mailing Address - Phone:781-688-0138
Mailing Address - Fax:
Practice Address - Street 1:11 VANDERBILT AVE STE 210
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5056
Practice Address - Country:US
Practice Address - Phone:781-688-0138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00486171100000X
MA281885171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDA00486Medicaid