Provider Demographics
NPI:1851486310
Name:PANG, GARY KIN TET (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:KIN TET
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:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-0224
Mailing Address - Country:US
Mailing Address - Phone:951-784-7111
Mailing Address - Fax:
Practice Address - Street 1:6900 BROCKTON AVENUE
Practice Address - Street 2:SUITE 103
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506
Practice Address - Country:US
Practice Address - Phone:951-784-7111
Practice Address - Fax:951-823-0378
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78054207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine