Provider Demographics
NPI:1164726709
Name:PANG, PANNY C (MPT)
Entity Type:Individual
Prefix:MS
First Name:PANNY
Middle Name:C
Last Name:PANG
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9940 WESTWANDA DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-1427
Mailing Address - Country:US
Mailing Address - Phone:310-994-4098
Mailing Address - Fax:
Practice Address - Street 1:9940 WESTWANDA DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-1427
Practice Address - Country:US
Practice Address - Phone:310-994-4098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT21799OtherCONSUMER AFFAIR