Provider Demographics
NPI:1366653149
Name:PENG, SAIJAI (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:SAIJAI
Middle Name:
Last Name:PENG
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PIERRE RD
Mailing Address - Street 2:#B
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2531
Mailing Address - Country:US
Mailing Address - Phone:909-595-4945
Mailing Address - Fax:
Practice Address - Street 1:100 PIERRE RD
Practice Address - Street 2:#B
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2531
Practice Address - Country:US
Practice Address - Phone:909-595-4945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics