Healthcare Provider Details

I. General information

NPI: 1538926670
Provider Name (Legal Business Name): BEILEI PENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST
SANTA ANA CA
92701-4599
US

IV. Provider business mailing address

18323 IRIS LN
YORBA LINDA CA
92886-8418
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-3101
  • Fax:
Mailing address:
  • Phone: 626-340-9574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberRDA99959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: