Provider Demographics
NPI:1598352312
Name:LANG, PO LUNG (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:PO
Middle Name:LUNG
Last Name:LANG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:PO
Other - Middle Name:LUNG
Other - Last Name:NGAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6861 ALAMO WAY
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-5860
Mailing Address - Country:US
Mailing Address - Phone:718-791-5126
Mailing Address - Fax:
Practice Address - Street 1:1309 COFFEEN AVE STE 1200
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5777
Practice Address - Country:US
Practice Address - Phone:307-302-0318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016187363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner