Healthcare Provider Details

I. General information

NPI: 1912840919
Provider Name (Legal Business Name): GUANGXIANG (GRACE) FENG MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15501 SAN FERNANDO MISSION BLVD STE 104
MISSION HILLS CA
91345-1364
US

IV. Provider business mailing address

15501 SAN FERNANDO MISSION BLVD STE 104
MISSION HILLS CA
91345-1364
US

V. Phone/Fax

Practice location:
  • Phone: 818-363-9178
  • Fax: 818-322-1316
Mailing address:
  • Phone: 626-540-9633
  • Fax: 818-322-1316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number90383
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: