Healthcare Provider Details

I. General information

NPI: 1134359961
Provider Name (Legal Business Name): CORILYN K. S. PANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-1480 MOANIANI ST
WAIPAHU HI
96797-4632
US

IV. Provider business mailing address

94-1480 MOANIANI ST
WAIPAHU HI
96797-4632
US

V. Phone/Fax

Practice location:
  • Phone: 808-432-3100
  • Fax:
Mailing address:
  • Phone: 808-432-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125055811
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036128807
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-17137
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: