MEDICARE: CINDY HM PENG D.P.M.

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1578853768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CINDY HM PENG D.P.M.

Provider Business Mailing Address
First Line	:	6542 SE LAKE RD
Second Line	:	UNIT 102
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-2244
Country	:	US
Telephone Number	:	503-659-6686
Fax Number	:

Provider Business Practice Location Address
First Line	:	6542 SE LAKE RD
Second Line	:	UNIT 102
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-2244
Country	:	US
Telephone Number	:	503-659-6686
Fax Number	:

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

Provider Enumeration Date	:	04/09/2011
Last Update Date	:	08/27/2014

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