Provider Demographics
NPI:1669597076
Name:PANG, SZE KIM (MD)
Entity type:Individual
Prefix:
First Name:SZE
Middle Name:KIM
Last Name:PANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 GALISTEO ST STE N9A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2111
Mailing Address - Country:US
Mailing Address - Phone:505-820-1482
Mailing Address - Fax:
Practice Address - Street 1:2019 GALISTEO ST STE N9A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2111
Practice Address - Country:US
Practice Address - Phone:505-820-1482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7071207Q00000X
NM2014-0495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHS19OPMedicaid
AKHS19IPMedicaid
AKHS19IPMedicaid
AKTEZ042Medicare PIN