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General NPI Number Information
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NPI Number | 1184817868
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Entity Type | Organization
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Legal Business Name | ERIC C.K. PENG, DDS, INC.
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Dates
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Enumeration Date | 08/25/2007
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 7615 GARVEY AVE
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City | ROSEMEAD
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State | CA
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Zip | 91770-3001
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Country | US
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Telephone | 626-307-4078
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Fax | 626-307-9432
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Provider Business Mailing Address
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Address Line | 7615 GARVEY AVE
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City | ROSEMEAD
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State | CA
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Zip | 91770-3001
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Country | US
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Telephone | 626-307-4078
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Fax | 626-307-9432
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ERIC CHICH-KUANG PENG
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Credential | DDS
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Telephone | 626-307-4078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 35017
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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