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General NPI Number Information
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NPI Number | 1043843170
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Entity Type | Individual
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Provider Name | JULIA KAI-CHIN PENG DDS
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Gender | Female
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Dates
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Enumeration Date | 02/17/2020
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Last Update Date | 01/20/2024
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Provider Practice Location Address
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Address Line | 2200 E PROSPER TRL STE 40
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City | PROSPER
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State | TX
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Zip | 75078-2783
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Country | US
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Telephone | 469-777-8982
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Fax |
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Provider Business Mailing Address
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Address Line | 12050 RESEARCH RD APT 8405
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City | FRISCO
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State | TX
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Zip | 75033-0195
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Country | US
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Telephone | 626-715-3771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 38269
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License Number State | TX
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