Provider Demographics
NPI:1750426532
Name:PENG, SHI-KAUNG (MD, PHD)
Entity type:Individual
Prefix:
First Name:SHI-KAUNG
Middle Name:
Last Name:PENG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W CARSON ST
Mailing Address - Street 2:BOX 480
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2004
Mailing Address - Country:US
Mailing Address - Phone:310-222-2201
Mailing Address - Fax:310-222-3879
Practice Address - Street 1:1000 W CARSON ST
Practice Address - Street 2:BOX 480
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:310-222-2201
Practice Address - Fax:310-222-3879
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31546207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA87563Medicare UPIN
CAWA31546DMedicare ID - Type UnspecifiedPPIN
CAWA31546EMedicare ID - Type UnspecifiedPPIN
CAWA1546CMedicare ID - Type UnspecifiedPPIN
CA00A315460Medicare ID - Type UnspecifiedMEDI-CAL NUMBER