Healthcare Provider Details

I. General information

NPI: 1669783239
Provider Name (Legal Business Name): FANG EMILY DENG M.D.,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 COLONIAL DR
COLUMBIA SC
29203-6930
US

IV. Provider business mailing address

3209 COLONIAL DR
COLUMBIA SC
29203-6930
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-7399
  • Fax: 803-434-7529
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberLL35974
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number60025-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: