Provider Demographics
NPI:1649553421
Name:PANG, SUZANNE
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:PANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 CLEMENT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2216
Mailing Address - Country:US
Mailing Address - Phone:415-668-5250
Mailing Address - Fax:415-668-1438
Practice Address - Street 1:745 CLEMENT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2216
Practice Address - Country:US
Practice Address - Phone:415-668-5250
Practice Address - Fax:415-668-1438
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist