Provider Demographics
NPI:1184018137
Name:PENG, LIFANG (PA-C)
Entity Type:Individual
Prefix:
First Name:LIFANG
Middle Name:
Last Name:PENG
Suffix:
Gender:F
Credentials:PA-C
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 5040
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-0040
Mailing Address - Country:US
Mailing Address - Phone:866-520-7619
Mailing Address - Fax:
Practice Address - Street 1:6401 TRUXTUN AVE STE B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0674
Practice Address - Country:US
Practice Address - Phone:661-327-9300
Practice Address - Fax:661-327-9301
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4426-023363A00000X
CAPA53943363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant