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General NPI Number Information
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NPI Number | 1235345422
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Entity Type | Individual
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Provider Name | JAMES H. PENG MFT, D.MIN.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2008 N GAREY AVE
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City | POMONA
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State | CA
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Zip | 91767-2722
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Country | US
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Telephone | 909-784-3000
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Fax | 909-865-9281
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Provider Business Mailing Address
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Address Line | 330 AMBERWOOD DR
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City | WALNUT
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State | CA
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Zip | 91789-2473
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Country | US
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Telephone | 909-784-3000
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Fax | 909-865-9281
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF52753
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License Number State | CA
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