Provider Demographics
NPI:1033391347
Name:PENG, RICHARD ZHEN (MS, MBA, RCEP, CDE)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ZHEN
Last Name:PENG
Suffix:
Gender:M
Credentials:MS, MBA, RCEP, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18311
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91416-8311
Mailing Address - Country:US
Mailing Address - Phone:818-981-0608
Mailing Address - Fax:
Practice Address - Street 1:15060 VICTORY BLVD
Practice Address - Street 2:UNIT 103
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1835
Practice Address - Country:US
Practice Address - Phone:818-426-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
322224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
21110333OtherNATIONAL CERTIFICATION BOARD FOR DIABETES EDUCATORS
322OtherACSM