Healthcare Provider Details

I. General information

NPI: 1336550649
Provider Name (Legal Business Name): XIN PENG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATE PENG

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 N HAMILTON RD
WESTERVILLE OH
43081-2062
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8536
  • Fax: 614-293-8902
Mailing address:
  • Phone: 614-293-8536
  • Fax: 614-293-8902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35143046
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: