Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | A61449 | CA |
NPI | 1154304103 |
---|---|
Provider Name | Dr. Rick Peng |
First Address | Houston, TX 77210-4439 |
Second Address | Houston, TX 77030-4000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 22/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08505 | PI (01) | CA |
I06974 | (02) | CA |