MEDICARE: DR. HAI EN PENG DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	E4368	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033305677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAI EN PENG DPM

Provider Business Mailing Address
First Line	:	2460 N PONDEROSA DR
Second Line	:	STE A105
City	:	CAMARILLO
State	:	CA
Zip	:	93010-2375
Country	:	US
Telephone Number	:	805-482-0711
Fax Number	:	805-482-6524

Provider Business Practice Location Address
First Line	:	2460 N PONDEROSA DR
Second Line	:	STE A105
City	:	CAMARILLO
State	:	CA
Zip	:	93010-2375
Country	:	US
Telephone Number	:	805-482-0711
Fax Number	:	805-482-6524

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	07/12/2023

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Directions to “ DR. HAI EN PENG DPM” Practice Location

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