Basic Information
| Provider Information | |||||||||
| NPI: | 1790985349 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PENG | ||||||||
| FirstName: | KUN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | PENG | ||||||||
| OtherFirstName: | DAVID | ||||||||
| OtherMiddleName: | K | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 120 SPALDING DR STE 308 | ||||||||
| Address2: | |||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605406521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305277730 | ||||||||
| FaxNumber: | 6305277732 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 SPALDING DR STE 308 | ||||||||
| Address2: | |||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305277730 | ||||||||
| FaxNumber: | 6305277732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2007 | ||||||||
| LastUpdateDate: | 01/18/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | 52249 | CT | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 207LP2900X | 036-143706 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | 4301089964 | MI | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | 52249 | CT | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 4301089964 | MI | N | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.