Individual
MISS KELLY CAROL PENG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
200 MERCY CIRCLE, EMERGENCY MEDICINE DEPARTMENT, OCEANSIDE, CA 92055
(760) 719-3994
Mailing address
200 MERCY CIRCLE, EMERGENCY MEDICINE DEPARTMENT, OCEANSIDE, CA 92055
(760) 719-3994
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
0102203540
VA
207P00000X
Emergency Medicine Physician
0102203540
VA
Other
Enumeration date
02/12/2012
Last updated
11/07/2023
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