Provider Demographics
NPI:1124260740
Name:PENG, TONG
Entity type:Individual
Prefix:
First Name:TONG
Middle Name:
Last Name:PENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 W VINE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-3972
Mailing Address - Country:US
Mailing Address - Phone:407-781-6088
Mailing Address - Fax:407-910-4773
Practice Address - Street 1:2611 W VINE ST STE 101
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3972
Practice Address - Country:US
Practice Address - Phone:407-781-6088
Practice Address - Fax:407-910-4773
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01136171100000X
FLAP 2383171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist