Healthcare Provider Details

I. General information

NPI: 1528089588
Provider Name (Legal Business Name): CHANG J FENG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 KEISLER DR
CARY NC
27518-7091
US

IV. Provider business mailing address

251 KEISLER DR
CARY NC
27518-7091
US

V. Phone/Fax

Practice location:
  • Phone: 919-803-0813
  • Fax: 919-803-0967
Mailing address:
  • Phone: 919-803-0813
  • Fax: 919-803-0967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number200400328
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number200400328
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: