MEDICARE: JASON PANG M.D.

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
1	207RN0300X	Nephrology Physician	A69884	CA
2	174400000X	Specialist	A69884	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679644181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON PANG M.D.

Provider Business Mailing Address
First Line	:	PO BOX 8047
Second Line	:
City	:	LA CRESCENTA
State	:	CA
Zip	:	91224-0047
Country	:	US
Telephone Number	:	949-770-1122
Fax Number	:	949-770-9189

Provider Business Practice Location Address
First Line	:	24712 CLARINGTON DR
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-4305
Country	:	US
Telephone Number	:	949-770-1122
Fax Number	:	949-770-9189

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	04/04/2013

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