MEDICARE: CRYSTAL TENG

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	390200000X	Student in an Organized Health Care Education/Training Program		CA

General Provider Information

NPI Number	:	1619409828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL TENG

Provider Business Mailing Address
First Line	:	1817 PEPPER ST
Second Line	:	APT 6
City	:	ALHAMBRA
State	:	CA
Zip	:	91801-3157
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1817 PEPPER ST
Second Line	:	APT 6
City	:	ALHAMBRA
State	:	CA
Zip	:	91801-3157
Country	:	US
Telephone Number	:	909-450-7476
Fax Number	:

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

Provider Enumeration Date	:	03/28/2017
Last Update Date	:	03/28/2017

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Directions to “ CRYSTAL TENG ” Practice Location

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