MEDICARE: DR. DIANE FENG D.M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS-029122-L	PA

General Provider Information

NPI Number	:	1275636177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE FENG D.M.D., PH.D.

Provider Business Mailing Address
First Line	:	1133 COTTMAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3647
Country	:	US
Telephone Number	:	215-742-7139
Fax Number	:	215-742-7139

Provider Business Practice Location Address
First Line	:	1133 COTTMAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3647
Country	:	US
Telephone Number	:	215-742-7139
Fax Number	:	215-742-7139

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/10/2007

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