MEDICARE: DR. WALDO C. FENG M.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	174400000X	Specialist	10623	NV
2	2088P0231X	Pediatric Urology Physician	NV10623	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639169774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALDO C. FENG M.D.

Provider Business Mailing Address
First Line	:	20 WADE HAMPTON TRL
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-6635
Country	:	US
Telephone Number	:	702-916-1996
Fax Number	:	702-916-1997

Provider Business Practice Location Address
First Line	:	3131 LA CANADA ST STE 205
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2578
Country	:	US
Telephone Number	:	702-916-1996
Fax Number	:	702-916-1997

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	03/17/2018

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