Basic Information
Provider Information
NPI: 1225477557
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FENG
FirstName: ALEXANDER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
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Mailing Information
Address1: 455 N GARFIELD AVE FL 2
Address2:  
City: MONTEREY PARK
State: CA
PostalCode: 917541201
CountryCode: US
TelephoneNumber: 8334767377
FaxNumber:  
Practice Location
Address1: 455 N GARFIELD AVE FL 2
Address2:  
City: MONTEREY PARK
State: CA
PostalCode: 917541201
CountryCode: US
TelephoneNumber: 8334767377
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/20/2013
LastUpdateDate: 07/04/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/04/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2081P2900XMD458831PAN Allopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
2081P2900XA154703CAY Allopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine

No ID Information.


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