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General NPI Number Information
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NPI Number | 1679644181
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Entity Type | Individual
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Provider Name | JASON PANG M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 04/04/2013
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Provider Practice Location Address
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Address Line | 24712 CLARINGTON DR
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-4305
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Country | US
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Telephone | 949-770-1122
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Fax | 949-770-9189
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Provider Business Mailing Address
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Address Line | PO BOX 8047
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City | LA CRESCENTA
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State | CA
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Zip | 91224-0047
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Country | US
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Telephone | 949-770-1122
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Fax | 949-770-9189
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A69884
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A69884
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License Number State | CA
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