Provider Demographics
NPI:1053654152
Name:MEREDITH KL PANG, M.D., INC
Entity Type:Organization
Organization Name:MEREDITH KL PANG, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:PANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-537-2932
Mailing Address - Street 1:1834 NUUANU AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2427
Mailing Address - Country:US
Mailing Address - Phone:808-537-2932
Mailing Address - Fax:808-537-2933
Practice Address - Street 1:1834 NUUANU AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2427
Practice Address - Country:US
Practice Address - Phone:808-537-2932
Practice Address - Fax:808-537-2933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1966207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI036563-01Medicaid
HIC-97561Medicare UPIN
HI036563-01Medicaid