Provider Demographics
NPI:1518086495
Name:JOHN PANG, D.O., P.A.
Entity Type:Organization
Organization Name:JOHN PANG, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PANG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-285-0221
Mailing Address - Street 1:PO BOX 850636
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75185-0636
Mailing Address - Country:US
Mailing Address - Phone:972-285-0221
Mailing Address - Fax:972-285-0223
Practice Address - Street 1:2858 N BELT LINE RD STE 600
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-9388
Practice Address - Country:US
Practice Address - Phone:972-285-0221
Practice Address - Fax:972-285-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092471401Medicaid
TX0924714-05OtherMEDICAID THSTEPS
TX080183431OtherRAILROAD MEDICARE
TX0924714-05OtherMEDICAID THSTEPS
TX080183431OtherRAILROAD MEDICARE