Provider Demographics
NPI:1144768078
Name:PENG, HUANHUAN
Entity Type:Individual
Prefix:
First Name:HUANHUAN
Middle Name:
Last Name:PENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11132 BRISTA WAY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-1330
Mailing Address - Country:US
Mailing Address - Phone:512-487-0451
Mailing Address - Fax:
Practice Address - Street 1:8140 N MOPAC EXPY STE 3-210
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8862
Practice Address - Country:US
Practice Address - Phone:512-493-9226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-12
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT3360207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty