Provider Demographics
NPI:1205110467
Name:PANG, ADA K (MS)
Entity type:Individual
Prefix:MS
First Name:ADA
Middle Name:K
Last Name:PANG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 164TH AVE NE
Mailing Address - Street 2:STE 200
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-7604
Mailing Address - Country:US
Mailing Address - Phone:206-457-3518
Mailing Address - Fax:
Practice Address - Street 1:8201 164TH AVE NE
Practice Address - Street 2:STE 200
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7604
Practice Address - Country:US
Practice Address - Phone:206-457-3518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60034558106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist