Provider Demographics
NPI:1679673370
Name:LEUNG-PANG, MIMI M (MS/LMFT)
Entity Type:Individual
Prefix:MS
First Name:MIMI
Middle Name:M
Last Name:LEUNG-PANG
Suffix:
Gender:F
Credentials:MS/LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39825 PASEO PADRE PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2974
Mailing Address - Country:US
Mailing Address - Phone:510-996-8685
Mailing Address - Fax:510-668-1660
Practice Address - Street 1:39825 PASEO PADRE PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2974
Practice Address - Country:US
Practice Address - Phone:510-996-8685
Practice Address - Fax:510-668-1660
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31360106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist