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General NPI Number Information
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NPI Number | 1700193786
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Entity Type | Organization
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Legal Business Name | DR DENG CLINIC LLC
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Dates
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Enumeration Date | 09/11/2010
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Last Update Date | 09/11/2010
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Provider Practice Location Address
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Address Line | 121 N 9TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-2410
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Country | US
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Telephone | 201-345-3532
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Fax |
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Provider Business Mailing Address
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Address Line | 500 E RIDGEWOOD AVE APT 17
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3340
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Country | US
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Telephone | 201-345-3532
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | XIAOYING DENG
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Credential | M.D.
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Telephone | 201-345-3532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD440933
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License Number State | PA
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