Provider Demographics
NPI:1467582718
Name:TOKUSHIGE PANG, LIANE S (MD)
Entity Type:Individual
Prefix:
First Name:LIANE
Middle Name:S
Last Name:TOKUSHIGE PANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LIANE
Other - Middle Name:S
Other - Last Name:TOKUSHIGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:459 PATTERSON RD 110
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1522
Mailing Address - Country:US
Mailing Address - Phone:808-433-0238
Mailing Address - Fax:
Practice Address - Street 1:1010 PENSACOLA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2118
Practice Address - Country:US
Practice Address - Phone:808-432-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-6148207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI071345-01Medicaid
HI00B0092771OtherHMSA BILLING NUMBER
HIH0000BDSZDMedicare PIN
HI00B0092771OtherHMSA BILLING NUMBER