Provider Demographics
NPI:1528156429
Name:PENG, YING (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:YING
Middle Name:
Last Name:PENG
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CORPORATE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2113
Mailing Address - Country:US
Mailing Address - Phone:949-215-6662
Mailing Address - Fax:949-215-6663
Practice Address - Street 1:333 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2113
Practice Address - Country:US
Practice Address - Phone:949-215-6662
Practice Address - Fax:949-215-6663
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA729812080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A729810Medicaid
CAI21164Medicare UPIN