Healthcare Provider Details

I. General information

NPI: 1790937803
Provider Name (Legal Business Name): DENG FAMILY MEDICINE CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 S DOUGLAS BLVD
MIDWEST CITY OK
73130-7194
US

IV. Provider business mailing address

2801 S DOUGLAS BLVD
MIDWEST CITY OK
73130-7194
US

V. Phone/Fax

Practice location:
  • Phone: 405-737-3278
  • Fax: 405-737-0240
Mailing address:
  • Phone: 405-737-3278
  • Fax: 405-737-0240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number22700
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ZEMING DENG
Title or Position: PRESIDENT
Credential: MD
Phone: 405-737-3278