Provider Demographics
NPI:1831148162
Name:PENG, TRACY J (MD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:J
Last Name:PENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1635 DIVISADERO STREET, SUITE 625, BOX 1821
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:166 GEARY ST, STE 1500 #1893
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108
Practice Address - Country:US
Practice Address - Phone:415-322-8130
Practice Address - Fax:415-353-7358
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA772502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A772500Medicaid
CA00A772500Medicaid
CA00A772500Medicare PIN