Healthcare Provider Details

I. General information

NPI: 1689802324
Provider Name (Legal Business Name): PENG DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W GARDENA BLVD
GARDENA CA
90247-4727
US

IV. Provider business mailing address

1700 W GARDENA BLVD
GARDENA CA
90247-4727
US

V. Phone/Fax

Practice location:
  • Phone: 310-323-0689
  • Fax:
Mailing address:
  • Phone: 310-323-0689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number46124
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. WENHONG FELIX PENG
Title or Position: PRESIDENT
Credential: DDS
Phone: 310-308-3204