Provider Demographics
NPI:1497941926
Name:PENG, LEI (PHD, OMD)
Entity Type:Individual
Prefix:DR
First Name:LEI
Middle Name:
Last Name:PENG
Suffix:
Gender:M
Credentials:PHD, OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 BIRCH ST
Mailing Address - Street 2:103
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2214
Mailing Address - Country:US
Mailing Address - Phone:949-757-1188
Mailing Address - Fax:
Practice Address - Street 1:4030 BIRCH ST
Practice Address - Street 2:103
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2214
Practice Address - Country:US
Practice Address - Phone:949-757-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9395171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist