Healthcare Provider Details

I. General information

NPI: 1881408409
Provider Name (Legal Business Name): KATIE BANG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8283 GROVE AVE STE 201
RANCHO CUCAMONGA CA
91730-3140
US

IV. Provider business mailing address

11300 NE 2ND AVE
MIAMI SHORES FL
33161-6628
US

V. Phone/Fax

Practice location:
  • Phone: 909-981-6644
  • Fax: 909-981-5048
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: