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NPI Code Detail

MEDICARE: KATHERINE PANG

MEDICARE: KATHERINE PANG
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine Physician191149CA

General Provider Information

NPI Number : 1053803627
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE PANG
Provider Business Mailing Address
First Line : 5767 W CENTURY BLVD STE 400
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-5631
Country : US
Telephone Number : 310-301-8771
Fax Number :
Provider Business Practice Location Address
First Line : 514 N PROSPECT AVE STE 103
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90277-3037
Country : US
Telephone Number : 310-376-8816
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2018
Last Update Date : 11/05/2021

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Directions to “ KATHERINE PANG ” Practice Location

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