Provider Demographics
NPI:1164214789
Name:PANG, NAOMI (MD)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:PANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OMI
Other - Middle Name:
Other - Last Name:PANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1112 FOUNTAIN ST APT A
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-3443
Mailing Address - Country:US
Mailing Address - Phone:808-542-1980
Mailing Address - Fax:
Practice Address - Street 1:14700 E OLD US HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1185
Practice Address - Country:US
Practice Address - Phone:734-475-1321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351054118390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program