Provider Demographics
NPI:1629454673
Name:KUE, PANG LEILANI (FNP-C)
Entity Type:Individual
Prefix:
First Name:PANG
Middle Name:LEILANI
Last Name:KUE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:PANG
Other - Middle Name:TSENG
Other - Last Name:KUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27805 VILLA CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-3731
Mailing Address - Country:US
Mailing Address - Phone:818-288-0039
Mailing Address - Fax:
Practice Address - Street 1:8781 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-2401
Practice Address - Country:US
Practice Address - Phone:818-920-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95002593363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner