Provider Demographics
NPI:1114587821
Name:PANG, ANDREA (RN, CPNP-PC, CNS)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:PANG
Suffix:
Gender:F
Credentials:RN, CPNP-PC, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 S CATALINA ST UNIT PH-N
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1740
Mailing Address - Country:US
Mailing Address - Phone:310-617-7463
Mailing Address - Fax:
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-2471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA797485363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP95007389OtherNURSE PRACTITIONER
CA797485OtherREGISTERED NURSE
MP5194802OtherDEA