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General NPI Number Information
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NPI Number | 1154716157
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Entity Type | Individual
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Provider Name | JONATHAN KAN KAN PANG M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/06/2015
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Last Update Date | 10/27/2023
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Provider Practice Location Address
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Address Line | 147 N BRENT ST
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City | VENTURA
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State | CA
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Zip | 93003-2809
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Country | US
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Telephone | 714-360-9266
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Fax |
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Provider Business Mailing Address
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Address Line | 1604 MULLIGAN ST
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City | OXNARD
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State | CA
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Zip | 93036-2571
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Country | US
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Telephone | 714-360-9266
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A145287
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License Number State | CA
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