Basic Information
Provider Information
NPI: 1962722645
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PANG
FirstName: LINDA
MiddleName: X
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6431 FANNIN STREET
Address2: MSB 5.111
City: HOUSTON
State: TX
PostalCode: 77030
CountryCode: US
TelephoneNumber: 7135006295
FaxNumber:  
Practice Location
Address1: 9105 N WAYSIDE DR
Address2:  
City: HOUSTON
State: TX
PostalCode: 770281030
CountryCode: US
TelephoneNumber: 7136332020
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/04/2010
LastUpdateDate: 11/08/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/21/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XQ8322TXN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RH0002XQ8322TXN Allopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
207RG0300XQ8322TXY Allopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine

ID Information
IDTypeStateIssuerDescription
36395280205TX MEDICAID
36395280305TX MEDICAID
36395280405TX MEDICAID


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