Healthcare Provider Details

I. General information

NPI: 1285800441
Provider Name (Legal Business Name): PENG HER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7280 RADHA DR
SACRAMENTO CA
95828-1468
US

IV. Provider business mailing address

7280 RADHA DR
SACRAMENTO CA
95828
US

V. Phone/Fax

Practice location:
  • Phone: 916-387-9870
  • Fax:
Mailing address:
  • Phone: 916-387-9870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: