Healthcare Provider Details

I. General information

NPI: 1417546268
Provider Name (Legal Business Name): SARAH PANG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E ONTARIO ST STE 700
CHICAGO IL
60611-3281
US

IV. Provider business mailing address

211 E ONTARIO ST STE 700
CHICAGO IL
60611-3281
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-0001
  • Fax: 312-926-6134
Mailing address:
  • Phone: 312-926-0001
  • Fax: 312-926-6134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085010206
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085010206
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: