Provider Demographics
NPI:1477585784
Name:PANG, MEREDITH KWECK LEONG
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:KWECK LEONG
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 1:1834 NUUANU AVE
Mailing Address - Street 2:#105
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817
Mailing Address - Country:US
Mailing Address - Phone:808-537-2932
Mailing Address - Fax:808-537-2933
Practice Address - Street 1:1834 NUUANU AVE
Practice Address - Street 2:#105
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817
Practice Address - Country:US
Practice Address - Phone:808-537-2932
Practice Address - Fax:808-537-2933
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD01966207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03656301Medicaid
HI03656301Medicaid
C97561Medicare UPIN