MEDICARE: DR. KEVIN ALBERT PENG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0901X	Otology & Neurotology Physician	A120366	CA

General Provider Information

NPI Number	:	1245556653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN ALBERT PENG M.D.

Provider Business Mailing Address
First Line	:	1245 WILSHIRE BLVD
Second Line	:	SOUTH TOWER STE 480
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4810
Country	:	US
Telephone Number	:	213-483-9930
Fax Number	:	562-967-2363

Provider Business Practice Location Address
First Line	:	1245 WILSHIRE BLVD
Second Line	:	SOUTH TOWER STE 480
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4810
Country	:	US
Telephone Number	:	213-483-9930
Fax Number	:	562-967-2363

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2010
Last Update Date	:	02/19/2026

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Directions to “ DR. KEVIN ALBERT PENG M.D.” Practice Location

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