Provider Demographics
NPI:1457349540
Name:OOI, JAMES PENG (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PENG
Last Name:OOI
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 1:320 SOLANO ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:CA
Mailing Address - Zip Code:96021-3454
Mailing Address - Country:US
Mailing Address - Phone:530-824-3283
Mailing Address - Fax:530-824-3285
Practice Address - Street 1:320 SOLANO ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021-3454
Practice Address - Country:US
Practice Address - Phone:530-824-3283
Practice Address - Fax:530-824-3285
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39127207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C391271Medicaid
CACLM302604OtherSTATE LAB LICENSE NUMBER
CA05D0959198OtherCLIA NUMBER
CA00C391270Medicaid
CA05D0570157OtherCLIA NUMBER
CALAB70157FOtherLAB
CA05D0570157OtherCLIA NUMBER
CAC04080Medicare UPIN
CA00C391720Medicare PIN