Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 290491 | NY |
N | 208600000X | Surgeon | 290491 | NY |
N | 208200000X | Surgeon | MD468184 | PA |
N | 208600000X | Surgeon | MD468184 | PA |
Y | 2086X0206X | Surgical Oncologist | MD468184 | PA |
NPI | 1124321252 |
---|---|
Provider Name | June Shujun Peng |
First Address | Hershey, PA 17033-0858 |
Second Address | Hershey, PA 17033-2360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2010 |
Last Update Date | 16/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1036594280001 | (05) | PA |