Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DT1746 | HI |
NPI | 1003902321 |
---|---|
Provider Name | Dr. Harrison Jen Hee Pang |
First Address | Aiea, HI 96701-3974 |
Second Address | Aiea, HI 96701-3974 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |