Healthcare Provider Details

I. General information

NPI: 1669146692
Provider Name (Legal Business Name): FANGYIN MENG MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 WATERWORKS WAY STE 110
IRVINE CA
92618-3171
US

IV. Provider business mailing address

47 BLUEJAY
IRVINE CA
92604-3273
US

V. Phone/Fax

Practice location:
  • Phone: 949-522-5033
  • Fax: 855-952-1976
Mailing address:
  • Phone: 134-727-7765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: FANGYIN MENG
Title or Position: DIRECTOR
Credential: MD
Phone: 134-727-7765