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: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

1530 CLARENDON BLVD APT 205
ARLINGTON VA
22209-4308
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-7000
  • Fax:
Mailing address:
  • Phone: 510-378-0018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: