Provider Demographics
NPI:1174568489
Name:PENG, STANFORD LEE-YU (MD, PHD, FACP)
Entity type:Individual
Prefix:DR
First Name:STANFORD
Middle Name:LEE-YU
Last Name:PENG
Suffix:
Gender:M
Credentials:MD, PHD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 E BLAINE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3983
Mailing Address - Country:US
Mailing Address - Phone:206-788-4545
Mailing Address - Fax:206-316-8383
Practice Address - Street 1:188 E BLAINE ST STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3983
Practice Address - Country:US
Practice Address - Phone:206-785-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60063017207R00000X, 207RR0500X
CAA92894207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A928940Medicaid
CA00A928940Medicare PIN
WAG8879238Medicare PIN
CAH57466Medicare UPIN