Healthcare Provider Details

I. General information

NPI: 1831148162
Provider Name (Legal Business Name): TRACY J. PENG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 01/07/2025
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 GEARY ST, STE 1500 #1893
SAN FRANCISCO CA
94108
US

IV. Provider business mailing address

1635 DIVISADERO STREET, SUITE 625, BOX 1821
SAN FRANCISCO CA
94143-0001
US

V. Phone/Fax

Practice location:
  • Phone: 415-322-8130
  • Fax: 415-353-7358
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA77250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: