Provider Demographics
NPI:1235213877
Name:PANG, DOROTHY Y (LAC)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:Y
Last Name:PANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 TRADAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-3714
Mailing Address - Country:US
Mailing Address - Phone:650-588-0888
Mailing Address - Fax:
Practice Address - Street 1:841 SAN BRUNO AVE W RM 10
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-3437
Practice Address - Country:US
Practice Address - Phone:650-588-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11286171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist