Healthcare Provider Details

I. General information

NPI: 1871600031
Provider Name (Legal Business Name): ZHEN ZHOU FENG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 12/09/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BICENTENNIAL WAY 240 MOB-W
SANTA ROSA CA
95403-2149
US

IV. Provider business mailing address

401 BICENTENNIAL WAY 240 MOB-W
SANTA ROSA CA
95403-2149
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-3621
  • Fax:
Mailing address:
  • Phone: 707-571-3621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301075723
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA100208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: