Provider Demographics
NPI:1669485447
Name:PENG, JOHN Y (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:Y
Last Name:PENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:19116 33RD AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4706
Practice Address - Country:US
Practice Address - Phone:425-771-7500
Practice Address - Fax:425-712-7903
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037612207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA110207377OtherRAILROAD MEDICARE
WA0039581OtherLABOR & INDUSTRY
WA3328PEOtherBLUE SHIELD
WAUS0818663OtherAETNA/USHC SPECIALIST
WA8254336Medicaid
WAAB15834Medicare PIN
WA3328PEOtherBLUE SHIELD
WAUS0818663OtherAETNA/USHC SPECIALIST
WA0039581OtherLABOR & INDUSTRY
WA110207377OtherRAILROAD MEDICARE
WA8254336Medicaid