Provider Demographics
NPI:1073053955
Name:PENG, SOPHIA CHUN LING (DMD)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:CHUN LING
Last Name:PENG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18351 COLIMA RD # 899
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2791
Mailing Address - Country:US
Mailing Address - Phone:626-715-3072
Mailing Address - Fax:
Practice Address - Street 1:18351 COLIMA RD # 899
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2791
Practice Address - Country:US
Practice Address - Phone:626-715-3072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101160122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist