MEDICARE: JACKY PENG

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	225100000X	Physical Therapist	306189	CA

General Provider Information

NPI Number	:	1508604489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKY PENG

Provider Business Mailing Address
First Line	:	1216 SIERRA TRAIL RD
Second Line	:
City	:	OAKLEY
State	:	CA
Zip	:	94561-5240
Country	:	US
Telephone Number	:	415-793-6802
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 SAND CREEK RD STE A
Second Line	:
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-2539
Country	:	US
Telephone Number	:	925-939-8585
Fax Number	:

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

Provider Enumeration Date	:	07/16/2024
Last Update Date	:	11/18/2025

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Directions to “ JACKY PENG ” Practice Location

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