Healthcare Provider Details

I. General information

NPI: 1598435034
Provider Name (Legal Business Name): PENG DING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # A71
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

6584 DUNEDEN AVE
SOLON OH
44139-4046
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-6691
  • Fax:
Mailing address:
  • Phone: 443-326-0016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.007226RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number50.007226RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: