Healthcare Provider Details

I. General information

NPI: 1639169774
Provider Name (Legal Business Name): WALDO C. FENG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 LA CANADA ST STE 205
LAS VEGAS NV
89169-2578
US

IV. Provider business mailing address

20 WADE HAMPTON TRL
HENDERSON NV
89052-6635
US

V. Phone/Fax

Practice location:
  • Phone: 702-916-1996
  • Fax: 702-916-1997
Mailing address:
  • Phone: 702-916-1996
  • Fax: 702-916-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number10623
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberNV10623
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: