Provider Demographics
NPI:1043843170
Name:PENG, JULIA KAI-CHIN (DDS)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:KAI-CHIN
Last Name:PENG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12050 RESEARCH RD APT 8405
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-0195
Mailing Address - Country:US
Mailing Address - Phone:626-715-3771
Mailing Address - Fax:
Practice Address - Street 1:2200 E PROSPER TRL STE 40
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2783
Practice Address - Country:US
Practice Address - Phone:469-777-8982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX382691223P0221X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry