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NPI Code Detail

MEDICARE: SOPHIA J. PENG M.D.

MEDICARE: SOPHIA J. PENG M.D.
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
1207R00000XInternal Medicine PhysicianDR.0060610CO
2207R00000XInternal Medicine Physician35125966OH
3207R00000XInternal Medicine Physician036157365IL
4208M00000XHospitalist PhysicianDR.0060610CO
5208M00000XHospitalist Physician036157365IL

General Provider Information

NPI Number : 1831455831
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOPHIA J. PENG M.D.
Provider Business Mailing Address
First Line : 1717 W CONGRESS PKWY STE 10
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3809
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1717 W CONGRESS PKWY STE 10
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3809
Country : US
Telephone Number : 312-942-3568
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2012
Last Update Date : 12/07/2022

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