MEDICARE: MRS. YINING PENG

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	225700000X	Massage Therapist	MA60972526	WA

General Provider Information

NPI Number	:	1134761497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YINING PENG

Provider Business Mailing Address
First Line	:	6720 REGENTS BLVD
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-5400
Country	:	US
Telephone Number	:	206-973-6208
Fax Number	:

Provider Business Practice Location Address
First Line	:	6720 REGENTS BLVD
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-5400
Country	:	US
Telephone Number	:	206-973-6208
Fax Number	:

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

Provider Enumeration Date	:	10/08/2019
Last Update Date	:	10/08/2019

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Directions to “ MRS. YINING PENG ” Practice Location

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