Provider Demographics
NPI:1083925580
Name:DEREK K H PANG MD INC
Entity Type:Organization
Organization Name:DEREK K H PANG MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:LILIBETH
Authorized Official - Middle Name:DOMINGO
Authorized Official - Last Name:CATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-523-1343
Mailing Address - Street 1:2228 LILIHA ST
Mailing Address - Street 2:401
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1650
Mailing Address - Country:US
Mailing Address - Phone:808-523-1343
Mailing Address - Fax:808-523-1345
Practice Address - Street 1:2228 LILIHA ST
Practice Address - Street 2:401
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1650
Practice Address - Country:US
Practice Address - Phone:808-523-1343
Practice Address - Fax:808-523-1345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3734174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04371823Medicaid
HI48892OtherHMSA
HI48892OtherHMSA
HIE72003Medicare UPIN