Provider Demographics
NPI:1548697352
Name:YING PENG MD, PH.D INC.
Entity type:Organization
Organization Name:YING PENG MD, PH.D INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YING
Authorized Official - Middle Name:
Authorized Official - Last Name:PENG, MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:949-215-6662
Mailing Address - Street 1:26451 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6362
Mailing Address - Country:US
Mailing Address - Phone:949-215-6662
Mailing Address - Fax:949-215-6663
Practice Address - Street 1:26451 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6362
Practice Address - Country:US
Practice Address - Phone:949-215-6662
Practice Address - Fax:949-215-6663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA729812080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental DisabilitiesGroup - Single Specialty