Cosmo Yuchen Peng, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE61217627 Issued in WA

Practice address

19111 SE 34TH St Ste 104
Vancouver, WA 98683-1449

Phone

(360) 823-0427

NPI assigned

Aug 3, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Jacob D Groom DMD PLLC

  dba Hiddenbrook Dental

  • General Practice Dentistry
  • Vancouver, WA
  • NPI 1699560300
  NPD (past)
• Wendel Family Dental Centre PS

  • General Practice Dentistry
  • Vancouver, WA
  • NPI 1295844900
  NPD (past)

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

{
    "created_epoch": "1596412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676937600000",
    "number": "1912517228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1062 NW DEERFERN LOOP",
            "city": "CAMAS",
            "state": "WA",
            "postal_code": "986078689",
            "telephone_number": "360-921-3656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19111 SE 34TH ST STE 104",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986831449",
            "telephone_number": "360-823-0427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENG",
        "first_name": "COSMO",
        "middle_name": "YUCHEN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-03",
        "last_updated": "2023-02-21",
        "certification_date": "2023-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11278",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE61217627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Misty Geneine Pelagalli, RC
• Robin Lysane Pelletier, PT, MPT
• Alexis Carrie Pelton, DMD
• Joylynn Comia Penaloza, PSY.D., LMHC
• Kathryn Pence, PA-C
• Doris T Peng, PHARMACIST
• Anna Pengra, MAT, LAT
• Michelle Hui Pengshung, MD
• Faith Pepino
• Tammy Pepper, RN, CCM

• General Practice Dentistry in Vancouver, WA
• Providers in Vancouver, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.