Provider Demographics
NPI:1154484376
Name:PANG, EDITH L (MD)
Entity Type:Individual
Prefix:DR
First Name:EDITH
Middle Name:L
Last Name:PANG
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1380 LUSITANA ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2449
Mailing Address - Country:US
Mailing Address - Phone:808-951-0433
Mailing Address - Fax:808-690-9821
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:SUITE 404
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2449
Practice Address - Country:US
Practice Address - Phone:808-951-0433
Practice Address - Fax:808-690-9821
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2010-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HI7381207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52029801Medicaid
HI52029801Medicaid
HIH55364Medicare ID - Type Unspecified