Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 20A12433 | CA |
NPI | 1285920090 |
---|---|
Provider Name | Edward Pang |
First Address | Los Angeles, CA 90069-0663 |
Second Address | Los Angeles, CA 90073-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2011 |
Last Update Date | 06/01/2018 |