Healthcare Provider Details

I. General information

NPI: 1245896877
Provider Name (Legal Business Name): AUSTIN DENG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 N CHURCH ST
VISALIA CA
93291-5008
US

IV. Provider business mailing address

3780 ROSIN CT STE 110
SACRAMENTO CA
95834-1698
US

V. Phone/Fax

Practice location:
  • Phone: 855-733-7772
  • Fax:
Mailing address:
  • Phone: 916-441-0226
  • Fax: 916-441-0286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number57230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: