Provider Demographics
NPI:1730787615
Name:PANG, MICHAEL HISAO MUN HO (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HISAO MUN HO
Last Name:PANG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12121 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-3737
Mailing Address - Country:US
Mailing Address - Phone:971-361-7700
Mailing Address - Fax:503-954-1095
Practice Address - Street 1:1350 NE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-2011
Practice Address - Country:US
Practice Address - Phone:503-408-7008
Practice Address - Fax:503-408-7045
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA201536363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical