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Provider Information for 1144378167

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

HENRY PENG MD

Gender: MALE

Individual NPI: 1144378167

Calendar   Last Updated:  2011-09-23
  Certification Date: 

Details

Name Value
NPI 1144378167
Enumeration Date 2007-01-08
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 624 W DUARTE RD SUITE 102
ARCADIA, CA 91007-7603
United States

Phone: 626-254-9540 | Fax: 626-294-2996
View Map External Link
Primary Practice Address 624 W DUARTE RD SUITE 102
ARCADIA, CA 91007-7603
United States

Phone: 626-254-9540 | Fax: 626-294-2996
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other STATE LICENSE CA A95408
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207Q00000X - Family Medicine CA A95408
No 2084S0010X - Psychiatry & Neurology Sports Medicine CA A95408