Provider Demographics
NPI:1548523350
Name:PENG, TUNAN (LAC)
Entity type:Individual
Prefix:
First Name:TUNAN
Middle Name:
Last Name:PENG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1432
Mailing Address - Country:US
Mailing Address - Phone:650-533-8598
Mailing Address - Fax:
Practice Address - Street 1:1289 E HILLSDALE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-1219
Practice Address - Country:US
Practice Address - Phone:650-533-8598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14868171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist