Active NPI
Kelly Carol Peng, D.O
- Emergency Medicine Physician
- San Diego, CA
National Provider Identifier
1013280718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 0102203540
- Practice address
- 34800 Bob Wilson Drive
Emergency Medicine Department
San Diego, CA 92134-0001 - Phone
- (619) 532-6400
- NPI assigned
- Feb 12, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Military Health Care Provider | 171000000X | 0102203540 | VA | |
| Emergency Medicine Physician | 207P00000X | 0102203540 | VA | Primary |
Addresses
Primary practice location
34800 Bob Wilson Drive
Emergency Medicine Department
San Diego, CA 92134-0001
Mailing address
34800 Bob Wilson Drive
Emergency Medicine Department
San Diego, CA 92134-0001
Phone (619) 532-6400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Emergency Medicine
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1901 W Harrison St
Chicago, IL 60612-3714
Phone (312) 633-7292
Hospital & facility affiliations
- John H Stroger Jr Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0102203540 | VA | MD | Military Health Care Provider |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cook County | Emergency Medicine | Current | Accepting new patients |
| Cook County | Current | Accepting new patients | |
| Cook County | Current | Accepting new patients |
Locations
500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000
1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100
13450 S Kedzie Ave
Robbins, IL 60472
Phone (708) 293-8100
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Chicago, IL
- NPI 1588612832
-
- Emergency Medicine Physician
- Chicago, IL
- NPI 1821385170
-
- Multi-Specialty Clinic/Center
- Chicago, IL
- NPI 1831219450
Hospital & facility affiliations 27
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1329004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785369600000",
"number": "1013280718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34800 BOB WILSON DRIVE",
"address_2": "EMERGENCY MEDICINE DEPARTMENT",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921340001",
"telephone_number": "619-532-6400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34800 BOB WILSON DRIVE",
"address_2": "EMERGENCY MEDICINE DEPARTMENT",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921340001",
"telephone_number": "619-532-6400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENG",
"first_name": "KELLY",
"middle_name": "CAROL",
"name_prefix": "Dr.",
"credential": "D.O",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-02-12",
"last_updated": "2026-07-30",
"certification_date": "2026-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "171000000X",
"taxonomy_group": "",
"desc": "Military Health Care Provider",
"state": "VA",
"license": "0102203540",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "VA",
"license": "0102203540",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.