Provider Demographics
NPI:1164050431
Name:YOU, PENG (MD)
Entity Type:Individual
Prefix:MR
First Name:PENG
Middle Name:
Last Name:YOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 KING STREET
Mailing Address - Street 2:UNIT 1109
Mailing Address - City:LONDON
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N6A OA5
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:71 KING STREET
Practice Address - Street 2:UNIT 1109
Practice Address - City:LONDON
Practice Address - State:ONTARIO
Practice Address - Zip Code:N6A OA5
Practice Address - Country:CA
Practice Address - Phone:519-619-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program