Basic Information
| Provider Information | |||||||||
| NPI: | 1679801435 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WANG | ||||||||
| FirstName: | PENG | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 ACKERMAN RD STE 2120 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432021559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142936196 | ||||||||
| FaxNumber: | 6143660073 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 ROSE ST # CC401B | ||||||||
| Address2: | DIV OF MEDICAL ONCOLOGY | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592574488 | ||||||||
| FaxNumber: | 8592577715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2009 | ||||||||
| LastUpdateDate: | 10/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | TP342 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RX0202X | 35145828 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
No ID Information.