Provider Demographics
NPI:1396827374
Name:PANG, YIJUN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:YIJUN
Middle Name:
Last Name:PANG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR LBBY J2000
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5301 E HURON RIVER DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-712-3161
Practice Address - Fax:734-712-2244
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086133207ZP0102X, 207ZC0500X
OH35.091830207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2588810Medicaid
MI4764908Medicaid
OHH104491Medicare PIN
OH2588810Medicaid
OHI39468Medicare UPIN
MI0H16101091Medicare ID - Type Unspecified
OH4236191Medicare PIN