Healthcare Provider Details

I. General information

NPI: 1417690827
Provider Name (Legal Business Name): YIFENG LU DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: YIFENG LV DO

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MAIN ST
SPRINGFIELD MA
01107-1112
US

IV. Provider business mailing address

280 CHESTNUT ST FL 2
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-5600
  • Fax: 413-794-7297
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.079255
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number1027952
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: