Provider Demographics
NPI:1043307754
Name:PANG, GLENN MUN LOK (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:MUN LOK
Last Name:PANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2226 LILIHA ST
Mailing Address - Street 2:#405
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817
Mailing Address - Country:US
Mailing Address - Phone:808-533-1708
Mailing Address - Fax:808-533-4796
Practice Address - Street 1:2226 LILIHA ST
Practice Address - Street 2:#405
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817
Practice Address - Country:US
Practice Address - Phone:808-533-1708
Practice Address - Fax:808-533-4796
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI3477207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01071301Medicaid
HI01071301Medicaid
D36217Medicare UPIN