Provider Demographics
NPI:1396404224
Name:PANG, BRIAN JONATHAN
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JONATHAN
Last Name:PANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18151 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1302
Mailing Address - Country:US
Mailing Address - Phone:626-623-0630
Mailing Address - Fax:
Practice Address - Street 1:15161 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MIDWAY CITY
Practice Address - State:CA
Practice Address - Zip Code:92655-1432
Practice Address - Country:US
Practice Address - Phone:714-897-3221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator