Provider Demographics
NPI:1912133372
Name:DR HARRISON JH PANG DMD, LLC
Entity Type:Organization
Organization Name:DR HARRISON JH PANG DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRISON
Authorized Official - Middle Name:JH
Authorized Official - Last Name:PANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, LLC
Authorized Official - Phone:808-486-4044
Mailing Address - Street 1:99-115 AIEA HEIGHTS DR
Mailing Address - Street 2:SUITE 224
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3924
Mailing Address - Country:US
Mailing Address - Phone:808-486-4044
Mailing Address - Fax:808-486-4044
Practice Address - Street 1:99-115 AIEA HEIGHTS DR
Practice Address - Street 2:SUITE 224
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3924
Practice Address - Country:US
Practice Address - Phone:808-486-4044
Practice Address - Fax:808-486-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-17461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty