Individual provider Active NPI

Jiun Rong Peng, MD

  • Orthopaedic Foot and Ankle Surgery Physician
  • Orange, CA
National Provider Identifier
1477540599
Registry record updated Sep 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Foot and Ankle Surgery PhysicianTaxonomy code 207XX0004X
License
A34348 Issued in CA
Practice address
280 S Main St
Suite 200
Orange, CA 92868-3852
Phone
(714) 634-4567
Fax
(714) 634-4569
NPI assigned
Oct 4, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X A34348 CA
Orthopaedic Foot and Ankle Surgery Physician 207XX0004X A34348 CA Primary

Addresses

Primary practice location

280 S Main St
Suite 200
Orange, CA 92868-3852

Mailing address

PO Box 905
Orange, CA 92856-6905

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041108000661 CA Practitioner - Orthopedic Surgery 4880657154 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
34348CAMDClinical Psychologist
A34348CAMDOrthopaedic Foot and Ankle Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California Orthopaedic Surgery CurrentSince Jul 1, 1986 Accepting new patients

Locations

101 The City Dr S
Orange, CA 92868
Phone (714) 456-6054

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443052800000",
    "number": "1477540599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 905",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928566905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 S MAIN ST",
            "address_2": "SUITE 200",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683852",
            "telephone_number": "714-634-4567",
            "fax_number": "714-634-4569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENG",
        "first_name": "JIUN",
        "middle_name": "RONG",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-04",
        "last_updated": "2015-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "A34348",
            "primary": false
        },
        {
            "code": "207XX0004X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": "CA",
            "license": "A34348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.