Provider Demographics
NPI:1285719815
Name:DENG, SOPHIE X
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:X
Last Name:DENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 RUSSELL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-6215
Mailing Address - Country:US
Mailing Address - Phone:301-987-0596
Mailing Address - Fax:301-987-0398
Practice Address - Street 1:957 RUSSELL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-6215
Practice Address - Country:US
Practice Address - Phone:301-987-0596
Practice Address - Fax:301-987-0398
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01138171100000X
MD17654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF578OtherDCBCBS
MDF850OtherDCBCBS
MD007328800Medicaid
MD553AHOOtherMDBCBS
MDBG41OtherMDBCBS
MD007328800Medicaid
MDBG41OtherMDBCBS