Provider Demographics
NPI:1790985349
Name:PENG, KUN (MD)
Entity Type:Individual
Prefix:
First Name:KUN
Middle Name:
Last Name:PENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:K
Other - Last Name:PENG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:120 SPALDING DR STE 308
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6521
Mailing Address - Country:US
Mailing Address - Phone:630-527-7730
Mailing Address - Fax:630-527-7732
Practice Address - Street 1:120 SPALDING DR STE 308
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540
Practice Address - Country:US
Practice Address - Phone:630-527-7730
Practice Address - Fax:630-527-7732
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT52249208VP0000X, 207L00000X
IL036-143706207LP2900X
MI4301089964207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH17604117Medicare PIN
M78510024Medicare PIN