Provider Demographics
NPI:1033388517
Name:LUON W PENG DO INC
Entity Type:Organization
Organization Name:LUON W PENG DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUON
Authorized Official - Middle Name:W
Authorized Official - Last Name:PENG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:323-222-4848
Mailing Address - Street 1:3731 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063-2401
Mailing Address - Country:US
Mailing Address - Phone:323-222-4848
Mailing Address - Fax:323-222-4800
Practice Address - Street 1:3731 E 3RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063-2401
Practice Address - Country:US
Practice Address - Phone:323-222-4848
Practice Address - Fax:323-222-4800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8244207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH66102Medicare UPIN