Basic Information
| Provider Information | |||||||||
| NPI: | 1164623559 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PENG | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | SHU-YUEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1977 BUTLER BLVD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770304101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137985900 | ||||||||
| FaxNumber: | 7197985841 | ||||||||
| Practice Location | |||||||||
| Address1: | 1977 BUTLER BLVD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770304101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137985900 | ||||||||
| FaxNumber: | 7197985841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 11/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YX0901X | 23397 | MN | N | Allopathic & Osteopathic Physicians | Otolaryngology | Otology & Neurotology | 207Y00000X | S1678 | TX | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.