Provider Demographics
NPI:1588778252
Name:PU, LEPING (MD)
Entity type:Individual
Prefix:
First Name:LEPING
Middle Name:
Last Name:PU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1685 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1703
Practice Address - Country:US
Practice Address - Phone:831-476-7711
Practice Address - Fax:831-475-5097
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1084762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCK1297OtherRAILROAD MEDICARE
OHP0029350OtherRAILROAD MEDICARE
CA1588778252Medicaid
OH2670239Medicaid
OH4177871Medicare PIN