Provider Demographics
NPI:1740476381
Name:KATIE R. PANG, M.D., INC
Entity type:Organization
Organization Name:KATIE R. PANG, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-308-0600
Mailing Address - Street 1:PO BOX 286
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91802-0286
Mailing Address - Country:US
Mailing Address - Phone:626-308-0600
Mailing Address - Fax:
Practice Address - Street 1:500 N GARFIELD AVE STE 102
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1242
Practice Address - Country:US
Practice Address - Phone:626-308-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84059207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty