MEDICARE: YUANBO FENG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	72753	CA

General Provider Information

NPI Number	:	1073053062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUANBO FENG

Provider Business Mailing Address
First Line	:	4547 HUDDART AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-1425
Country	:	US
Telephone Number	:	626-478-5780
Fax Number	:

Provider Business Practice Location Address
First Line	:	1726 SUPERIOR AVE
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-3615
Country	:	US
Telephone Number	:	949-629-9714
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2017
Last Update Date	:	02/24/2017

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Directions to “ YUANBO FENG ” Practice Location

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