Provider Demographics
NPI:1447477054
Name:PANG, JASON S (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:S
Last Name:PANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5528 E LA PALMA AVE STE 4A
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2115
Mailing Address - Country:US
Mailing Address - Phone:714-970-0200
Mailing Address - Fax:
Practice Address - Street 1:230 S MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3851
Practice Address - Country:US
Practice Address - Phone:714-541-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA969592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A969590Medicaid
CABX864ZMedicare PIN