Provider Demographics
NPI:1578853768
Name:PENG, CINDY HM (DPM)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:HM
Last Name:PENG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6542 SE LAKE RD
Mailing Address - Street 2:UNIT 102
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2244
Mailing Address - Country:US
Mailing Address - Phone:503-659-6686
Mailing Address - Fax:
Practice Address - Street 1:6542 SE LAKE RD
Practice Address - Street 2:UNIT 102
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-2244
Practice Address - Country:US
Practice Address - Phone:503-659-6686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-09
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program