Provider Demographics
NPI:1114024890
Name:EDITH L. PANG M.D. INC.
Entity Type:Organization
Organization Name:EDITH L. PANG M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:L
Authorized Official - Last Name:PANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-951-0433
Mailing Address - Street 1:1481 S KING ST STE 528
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2603
Mailing Address - Country:US
Mailing Address - Phone:808-951-0433
Mailing Address - Fax:808-942-2181
Practice Address - Street 1:1481 S KING ST STE 528
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2603
Practice Address - Country:US
Practice Address - Phone:808-951-0433
Practice Address - Fax:808-942-2181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI207R00000X207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52029801Medicaid
HI52029801Medicaid
HIH55364Medicare ID - Type Unspecified