Provider Demographics
NPI:1174073803
Name:EDITH PANG MD LLC
Entity type:Organization
Organization Name:EDITH PANG MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:L
Authorized Official - Last Name:PANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-690-9888
Mailing Address - Street 1:1380 LUSITANA ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2449
Mailing Address - Country:US
Mailing Address - Phone:808-690-9888
Mailing Address - Fax:808-690-9821
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:SUITE 404
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2449
Practice Address - Country:US
Practice Address - Phone:808-690-9888
Practice Address - Fax:808-690-9821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD7381207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty