Provider Demographics
NPI:1770847444
Name:PENG, YACHEN TERRI (BACB)
Entity Type:Individual
Prefix:
First Name:YACHEN
Middle Name:TERRI
Last Name:PENG
Suffix:
Gender:F
Credentials:BACB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-2101
Mailing Address - Country:US
Mailing Address - Phone:626-943-7772
Mailing Address - Fax:626-943-7730
Practice Address - Street 1:9060 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91775-1332
Practice Address - Country:US
Practice Address - Phone:626-943-7772
Practice Address - Fax:626-943-7730
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP112090103K00000X
CA225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst