Provider Demographics
NPI:1912563826
Name:PENG MD PLLC
Entity Type:Organization
Organization Name:PENG MD PLLC
Other - Org Name:AMITY NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HSIAOLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-299-5892
Mailing Address - Street 1:500 DAMONTE RANCH PKWY STE 1030
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5968
Mailing Address - Country:US
Mailing Address - Phone:775-432-6189
Mailing Address - Fax:775-284-5625
Practice Address - Street 1:500 DAMONTE RANCH PKWY STE 1030
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5968
Practice Address - Country:US
Practice Address - Phone:775-432-6189
Practice Address - Fax:775-284-5625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Single Specialty