Healthcare Provider Details

I. General information

NPI: 1427819275
Provider Name (Legal Business Name): CONGDE FENG L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALIX FENG L.AC

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 01/18/2024
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 CASTRO ST
MOUNTAIN VIEW CA
94041-1205
US

IV. Provider business mailing address

39625 BANYAN TREE RD
FREMONT CA
94538-1815
US

V. Phone/Fax

Practice location:
  • Phone: 650-691-1055
  • Fax:
Mailing address:
  • Phone: 510-770-4454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19888
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: