Provider Demographics
NPI:1689693640
Name:PANG, JOHN JAKES (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JAKES
Last Name:PANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13420 STATE HIGHWAY 249 STE I
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77086-3167
Mailing Address - Country:US
Mailing Address - Phone:281-999-7601
Mailing Address - Fax:281-999-7881
Practice Address - Street 1:13420 STATE HIGHWAY 249 STE I
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77086-3167
Practice Address - Country:US
Practice Address - Phone:281-999-7601
Practice Address - Fax:281-999-7881
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092471401Medicaid
TX092471405Medicaid
TX092471401Medicaid