Provider Demographics
NPI:1407937105
Name:PENG, LUON W (DO)
Entity Type:Individual
Prefix:
First Name:LUON
Middle Name:W
Last Name:PENG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063-2401
Mailing Address - Country:US
Mailing Address - Phone:323-222-4848
Mailing Address - Fax:323-222-4800
Practice Address - Street 1:3731 E 3RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063-2401
Practice Address - Country:US
Practice Address - Phone:323-222-4848
Practice Address - Fax:323-222-4800
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8244207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H66102Medicare UPIN
H66102Medicare UPIN