Provider Demographics
NPI:1962449561
Name:PENG, FANGYU (MD)
Entity Type:Individual
Prefix:
First Name:FANGYU
Middle Name:
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 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:NE3.240
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-8542
Mailing Address - Country:US
Mailing Address - Phone:214-645-2625
Mailing Address - Fax:214-645-6479
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:NE3.240
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-8542
Practice Address - Country:US
Practice Address - Phone:214-645-2625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1833207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM76490221OtherMIDICARE PROVIDER NUMBER