MEDICARE: CONGDE FENG L.AC

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	171100000X	Acupuncturist	19888	CA

General Provider Information

NPI Number	:	1427819275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONGDE FENG L.AC

Provider Business Mailing Address
First Line	:	39625 BANYAN TREE RD
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94538-1815
Country	:	US
Telephone Number	:	510-770-4454
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 CASTRO ST
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94041-1205
Country	:	US
Telephone Number	:	650-691-1055
Fax Number	:

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

Provider Enumeration Date	:	01/18/2024
Last Update Date	:	01/18/2024

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