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General NPI Number Information
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NPI Number | 1700405123
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Entity Type | Organization
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Legal Business Name | YAWEN PENG DMD INCORPORATED
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Dates
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Enumeration Date | 04/15/2020
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Last Update Date | 04/15/2020
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Provider Practice Location Address
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Address Line | 4606 HOLLYWOOD BLVD STE B
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City | LOS ANGELES
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State | CA
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Zip | 90027-5462
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Country | US
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Telephone | 323-663-3850
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Fax |
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Provider Business Mailing Address
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Address Line | 4606 HOLLYWOOD BLVD STE B
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City | LOS ANGELES
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State | CA
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Zip | 90027-5462
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | YAWEN PENG
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Credential |
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Telephone | 323-663-3850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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