Healthcare Provider Details

I. General information

NPI: 1689983751
Provider Name (Legal Business Name): DR. KIM T. PANG, M.D.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2010
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12113 NEW HAMPSHIRE AVE
SILVER SPRING MD
20904-2868
US

IV. Provider business mailing address

12113 NEW HAMPSHIRE AVE
SILVER SPRING MD
20904-2868
US

V. Phone/Fax

Practice location:
  • Phone: 301-384-3819
  • Fax: 301-622-2309
Mailing address:
  • Phone: 301-384-3819
  • Fax: 301-622-2309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD0030394
License Number StateMD

VIII. Authorized Official

Name: DR. KIM T. PANG
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 301-384-3819