Provider Demographics
NPI:1902979883
Name:ANG, NADEZNA LYN P (MD)
Entity Type:Individual
Prefix:
First Name:NADEZNA LYN
Middle Name:P
Last Name:ANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NALYN
Other - Middle Name:P
Other - Last Name:ANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1292 WAIANUENUE AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1228
Mailing Address - Country:US
Mailing Address - Phone:808-934-4000
Mailing Address - Fax:
Practice Address - Street 1:1292 WAIANUENUE AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-1228
Practice Address - Country:US
Practice Address - Phone:808-934-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-11379207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000229690OtherHMSA BILLING NUMBER
HI504888-01Medicaid
HIH37567Medicare UPIN
HI504888-01Medicaid