Healthcare Provider Details

I. General information

NPI: 1891202263
Provider Name (Legal Business Name): EDWARD K. PANG MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2018
Last Update Date: 01/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 S SAN VICENTE BLVD STE 901
LOS ANGELES CA
90048-4174
US

IV. Provider business mailing address

PO BOX 69663
WEST HOLLYWOOD CA
90069-0663
US

V. Phone/Fax

Practice location:
  • Phone: 310-860-3450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A12433
License Number StateCA

VIII. Authorized Official

Name: EDWARD PANG
Title or Position: PRESIDENT
Credential: D.O.
Phone: 310-860-3450