Individual
ALBERT PENG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2725 MENDOCINO AVE, SANTA ROSA, CA 95403-2805
(707) 545-4537
(707) 545-6726
Mailing address
2725 MENDOCINO AVE, SANTA ROSA, CA 95403-2805
(707) 542-6313
(075) 456-7267
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
A75807
CA
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
A75807
CA
207NS0135X
Procedural Dermatology Physician
A75807
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609862820
—
CA
01
—
P01774450
RAILROAD MEDICARE
CA
Enumeration date
09/22/2005
Last updated
02/26/2021
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