Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016005863 | IL |
Y | 222Z00000X | Podiatrist | 016005863 | IL |
NPI | 1013321199 |
---|---|
Provider Name | Dr. Kenneth Feng |
First Address | Chicago, IL 60613-2007 |
Second Address | Chicago, IL 60613-2007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2014 |
Last Update Date | 18/02/2021 |