MEDICARE: DR. SCOTT W PENKOFF MD

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	207Q00000X	Family Medicine Physician	G47766	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G47766	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1770761132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT W PENKOFF MD

Provider Business Mailing Address
First Line	:	18200 YORBA LINDA BLVD
Second Line	:	SUITE 401
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-4056
Country	:	US
Telephone Number	:	714-646-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	18300 YORBA LINDA BLVD
Second Line	:	SUITE 204
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-4052
Country	:	US
Telephone Number	:	714-646-8000
Fax Number	:

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

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	05/17/2026

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