Healthcare Provider Details

I. General information

NPI: 1033391347
Provider Name (Legal Business Name): RICHARD ZHEN PENG MS, MBA, RCEP, CDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15060 VICTORY BLVD UNIT 103
VAN NUYS CA
91411-1835
US

IV. Provider business mailing address

PO BOX 18311
ENCINO CA
91416-8311
US

V. Phone/Fax

Practice location:
  • Phone: 818-426-7711
  • Fax:
Mailing address:
  • Phone: 818-981-0608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number322
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: