Healthcare Provider Details

I. General information

NPI: 1821675018
Provider Name (Legal Business Name): EMILY FENG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 CANAL ST
MALDEN MA
02148-6701
US

IV. Provider business mailing address

2020 E 28TH ST STE 104
MINNEAPOLIS MN
55407-1925
US

V. Phone/Fax

Practice location:
  • Phone: 781-338-0055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number1021240
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: