Provider Demographics
NPI:1922363118
Name:PANG, SOPHIA (BA)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:PANG
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2179 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1520
Mailing Address - Country:US
Mailing Address - Phone:415-361-7149
Mailing Address - Fax:
Practice Address - Street 1:10 NOTTINGHAM PL
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4523
Practice Address - Country:US
Practice Address - Phone:415-361-7149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health