Provider Demographics
NPI:1194925925
Name:PENG, CHANG HE (LAC)
Entity type:Individual
Prefix:MR
First Name:CHANG
Middle Name:HE
Last Name:PENG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:25930 KAY AVE
Mailing Address - Street 2:APT 202
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-2658
Mailing Address - Country:US
Mailing Address - Phone:510-598-5883
Mailing Address - Fax:
Practice Address - Street 1:25930 KAY AVE
Practice Address - Street 2:APT 202
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-2658
Practice Address - Country:US
Practice Address - Phone:510-598-5883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9292171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist