Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | G85681 | CA |
NPI | 1023058195 |
---|---|
Provider Name | Dr. Yuchi Peter Peng |
First Address | Palmdale, CA 93551-4385 |
Second Address | Lancaster, CA 93534-4088 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 25/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G856810 | (05) | CA |
F66413 | (02) | CA |
ZZZ8386Z | (05) | CA |