Provider Demographics
NPI:1942454749
Name:PENN, STEVE (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:
Last Name:PENN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:SHU
Other - Middle Name:
Other - Last Name:PENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1758 SIERRA LEONE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-5837
Mailing Address - Country:US
Mailing Address - Phone:626-839-2938
Mailing Address - Fax:626-898-4711
Practice Address - Street 1:1758 SIERRA LEONE AVE STE A
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-5837
Practice Address - Country:US
Practice Address - Phone:626-839-2938
Practice Address - Fax:626-898-4711
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13661152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1942454749Medicaid
CABE282WMedicare PIN