Provider Demographics
NPI:1013798701
Name:PANG, VAN TROI (LAC)
Entity Type:Individual
Prefix:
First Name:VAN TROI
Middle Name:
Last Name:PANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MONTGOMERY ST APT 10F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-6529
Mailing Address - Country:US
Mailing Address - Phone:415-939-5893
Mailing Address - Fax:
Practice Address - Street 1:7552 113TH ST STE BF
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7496
Practice Address - Country:US
Practice Address - Phone:415-939-5893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007106-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist