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NPI Code Detail

MEDICARE: MS. CAN PENG PA-C

MEDICARE: MS. CAN PENG PA-C
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
1363A00000XPhysician Assistant5601013653MI

General Provider Information

NPI Number : 1326854225
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CAN PENG PA-C
Provider Business Mailing Address
First Line : 400 MACK AVE
Second Line :
City : DETROIT
State : MI
Zip : 48201-2136
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3990 JOHN R ST
Second Line :
City : DETROIT
State : MI
Zip : 48201-2018
Country : US
Telephone Number : 313-745-8040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2024
Last Update Date : 02/09/2026

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Directions to “ MS. CAN PENG PA-C” Practice Location

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