Provider Demographics
NPI:1467561340
Name:PANG, JEFFREY C N (LAC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C N
Last Name:PANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:CHUN
Other - Middle Name:NANG
Other - Last Name:PANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3401 WHITMAN WY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132
Mailing Address - Country:US
Mailing Address - Phone:408-926-8658
Mailing Address - Fax:
Practice Address - Street 1:3401 WHITMAN WY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132
Practice Address - Country:US
Practice Address - Phone:408-729-1109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2420171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0270612OtherMEDICAL PIN #
CAAC0024200Medicare ID - Type UnspecifiedMEDICAL