Provider Demographics
NPI:1033716311
Name:PANG, CHI WING (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:CHI WING
Middle Name:
Last Name:PANG
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:
Other - Last Name:PANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1530 CLARENDON BLVD APT 205
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-4308
Mailing Address - Country:US
Mailing Address - Phone:510-378-0018
Mailing Address - Fax:
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:202-877-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1048464163WC0200X, 363LA2100X
VA0024183514363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care