Provider Demographics
NPI:1912301151
Name:PANG, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:PANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAMES VICTOR
Other - Middle Name:VIADO
Other - Last Name:PANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:33408 1ST LN S
Mailing Address - Street 2:APT C
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6232
Mailing Address - Country:US
Mailing Address - Phone:773-633-1328
Mailing Address - Fax:
Practice Address - Street 1:30601 34TH PL S
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-3201
Practice Address - Country:US
Practice Address - Phone:206-592-6964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60377251163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health