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General NPI Number Information
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NPI Number | 1770697112
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Entity Type | Individual
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Provider Name | MARLENE PENG MD
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Gender | Female
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 515 MINOR AVE 3RD FLOOR
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City | SEATTLE
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State | WA
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Zip | 98104-2120
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Country | US
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Telephone | 206-386-9500
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Fax | 206-576-3802
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Provider Business Mailing Address
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Address Line | 515 MINOR AVE
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City | SEATTLE
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State | WA
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Zip | 98104-2120
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Country | US
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Telephone | 206-386-9500
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Fax | 206-576-3802
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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 | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | MD60102678
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 68453341205
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number | 46653
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License Number State | WI
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