Healthcare Provider Details

I. General information

NPI: 1033716311
Provider Name (Legal Business Name): CHI WING PANG ACNPC-AG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JEFFREY PANG

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE BLDG. 5, 3M
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

1001 POTRERO AVE BLDG. 5, 3M
SAN FRANCISCO CA
94110-3518
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-8265
  • Fax: 628-206-4259
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberNP95036839
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN1048464
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024183514
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN1048464
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: