Healthcare Provider Details

I. General information

NPI: 1649835240
Provider Name (Legal Business Name): STEPHANIE PANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 HARRISON ST
SAN FRANCISCO CA
94107-1235
US

IV. Provider business mailing address

188 BROOKLAWN AVE
DALY CITY CA
94015-3527
US

V. Phone/Fax

Practice location:
  • Phone: 415-836-1700
  • Fax:
Mailing address:
  • Phone: 415-513-8621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: