Provider Demographics
NPI:1821199233
Name:PANG, DEREK KWOCK HEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:KWOCK HEEN
Last Name:PANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 LILIHA ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-3522
Mailing Address - Country:US
Mailing Address - Phone:808-523-1343
Mailing Address - Fax:808-523-1345
Practice Address - Street 1:1425 LILIHA ST
Practice Address - Street 2:SUITE 11
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3522
Practice Address - Country:US
Practice Address - Phone:808-523-1343
Practice Address - Fax:808-523-1345
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3734207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04371823Medicaid
48892OtherHMSA
HI192089OtherHMA/HMN
HI0000BDHHKMedicare ID - Type Unspecified
HI192089OtherHMA/HMN