Provider Demographics
NPI:1437423019
Name:CHEN-PENG, LIN L (PHARMD)
Entity Type:Individual
Prefix:
First Name:LIN
Middle Name:L
Last Name:CHEN-PENG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LIN
Other - Middle Name:L
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1875 GAMAY TER
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1253
Mailing Address - Country:US
Mailing Address - Phone:619-890-8887
Mailing Address - Fax:
Practice Address - Street 1:408 ALTA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92158-0001
Practice Address - Country:US
Practice Address - Phone:619-661-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist