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General NPI Number Information
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NPI Number | 1396232138
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Entity Type | Individual
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Provider Name | MR. WINSTON FENG
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Gender | Male
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Dates
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Enumeration Date | 04/17/2018
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 4108 N SHERIDAN RD
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City | CHICAGO
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State | IL
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Zip | 60613-2007
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Country | US
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Telephone | 773-549-6116
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Fax |
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Provider Business Mailing Address
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Address Line | 515 ILLINOIS RD
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City | WILMETTE
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State | IL
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Zip | 60091-2340
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Country | US
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Telephone | 847-529-4257
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 19031747
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License Number State | IL
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