Healthcare Provider Details

I. General information

NPI: 1538556394
Provider Name (Legal Business Name): ALBERT W FENG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ SUITE 3304
LOS ANGELES CA
90095-8358
US

IV. Provider business mailing address

PO BOX 515412
LOS ANGELES CA
90051-6712
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-8653
  • Fax:
Mailing address:
  • Phone: 949-764-5438
  • Fax: 949-764-5430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA147304
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: