Healthcare Provider Details

I. General information

NPI: 1164956959
Provider Name (Legal Business Name): JOYCE PANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON ST STE 510
SEATTLE WA
98104-3557
US

IV. Provider business mailing address

1101 MADISON ST STE 510
SEATTLE WA
98104-3557
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-2550
  • Fax:
Mailing address:
  • Phone: 206-386-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberMD.MD.70015555
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: