Healthcare Provider Details

I. General information

NPI: 1992382287
Provider Name (Legal Business Name): JIMMY JI FENG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 AVENUE O
BROOKLYN NY
11204-6542
US

IV. Provider business mailing address

1789 W 12TH ST
BROOKLYN NY
11223-1145
US

V. Phone/Fax

Practice location:
  • Phone: 347-559-3808
  • Fax:
Mailing address:
  • Phone: 631-444-3005
  • Fax: 631-444-7534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number200570
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number334435
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: