Provider Demographics
NPI:1801898713
Name:PENG, CHIUSHEUE SHERRY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:CHIUSHEUE
Middle Name:SHERRY
Last Name:PENG
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MISS
Other - First Name:SHERRY
Other - Middle Name:
Other - Last Name:PENG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITTIONER
Mailing Address - Street 1:4040 VIA MARISOL
Mailing Address - Street 2:#321
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-5154
Mailing Address - Country:US
Mailing Address - Phone:323-224-6982
Mailing Address - Fax:
Practice Address - Street 1:1500 SAN PABLO ST
Practice Address - Street 2:CARDIACTHORACIC SUGERY UNIT
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5313
Practice Address - Country:US
Practice Address - Phone:323-442-8869
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP15174363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner