Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 25MA09518800 | NJ |
Y | 2080P0201X | Pediatric Allergist | A136879 | CA |
NPI | 1770999765 |
---|---|
Provider Name | Tammy Peng |
First Address | Los Angeles, CA 90095-1752 |
Second Address | Los Angeles, CA 90095 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2014 |
Last Update Date | 01/06/2018 |