Provider Demographics
NPI:1154523249
Name:FENG, YUE JIN (OMD)
Entity type:Individual
Prefix:MISS
First Name:YUE JIN
Middle Name:
Last Name:FENG
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 LINCOLN BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1710
Mailing Address - Country:US
Mailing Address - Phone:310-458-8873
Mailing Address - Fax:
Practice Address - Street 1:1227 LINCOLN BLVD STE 302
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1710
Practice Address - Country:US
Practice Address - Phone:310-458-8873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACV2871171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist