Healthcare Provider Details

I. General information

NPI: 1629444864
Provider Name (Legal Business Name): SAIJAI PENG DDS, MSD, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PIERRE RD STE B
WALNUT CA
91789-2565
US

IV. Provider business mailing address

100 PIERRE RD STE B
WALNUT CA
91789-2565
US

V. Phone/Fax

Practice location:
  • Phone: 909-595-4945
  • Fax:
Mailing address:
  • Phone: 909-595-4945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number32380
License Number StateCA

VIII. Authorized Official

Name: DR. SAIJAI PENG
Title or Position: PRESIDENT
Credential: DDS
Phone: 909-595-4945