Provider Demographics
NPI:1083687685
Name:PANG, LAETON J (MD)
Entity Type:Individual
Prefix:DR
First Name:LAETON
Middle Name:J
Last Name:PANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 PUNCHBOWL ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2402
Mailing Address - Country:US
Mailing Address - Phone:808-547-4771
Mailing Address - Fax:808-547-4507
Practice Address - Street 1:1650 LILIHA ST
Practice Address - Street 2:SUITE 105
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3169
Practice Address - Country:US
Practice Address - Phone:808-524-3131
Practice Address - Fax:808-524-3189
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI85942085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIF42033OtherHMSA
HI03830107Medicaid
HIH56638Medicare PIN
HIF42033OtherHMSA