Provider Demographics
NPI:1609165539
Name:PENG, ENMIN
Entity type:Individual
Prefix:MR
First Name:ENMIN
Middle Name:
Last Name:PENG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ENMIN
Other - Middle Name:
Other - Last Name:PENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:3849 DE LA CRUZ BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-2117
Mailing Address - Country:US
Mailing Address - Phone:650-274-8320
Mailing Address - Fax:408-899-4296
Practice Address - Street 1:39210 STATE STREET STE 213
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:650-212-7968
Practice Address - Fax:408-899-4296
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13140171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist