Provider Demographics
NPI:1235345422
Name:PENG, JAMES H (MFT, DMIN)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:H
Last Name:PENG
Suffix:
Gender:M
Credentials:MFT, DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 AMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2473
Mailing Address - Country:US
Mailing Address - Phone:909-784-3000
Mailing Address - Fax:909-865-9281
Practice Address - Street 1:2008 N GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2722
Practice Address - Country:US
Practice Address - Phone:909-784-3000
Practice Address - Fax:909-865-9281
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF52753106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist