Provider Demographics
NPI:1629444864
Name:SAIJAI PENG DDS, MSD, APC
Entity Type:Organization
Organization Name:SAIJAI PENG DDS, MSD, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAIJAI
Authorized Official - Middle Name:
Authorized Official - Last Name:PENG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-595-4945
Mailing Address - Street 1:100 PIERRE RD STE B
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2565
Mailing Address - Country:US
Mailing Address - Phone:909-595-4945
Mailing Address - Fax:
Practice Address - Street 1:100 PIERRE RD STE B
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2565
Practice Address - Country:US
Practice Address - Phone:909-595-4945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty