Pang Ko, D.M.D.
Individual provider Active NPI Dentist · Edwards, CA
NPI 1144613670 · NPPES record last updated Feb 24, 2020
Key facts
- NPI
- 1144613670
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 64986 (CA)
- Practice address
- 30 Nightingale Ave Building 5513
Edwards, CA 93524-0001 - Phone
- (661) 277-2872
- NPI assigned
- Mar 9, 2015
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64986 | CA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 64986 | CA | Yes |
Addresses
Primary practice location
30 Nightingale Ave Building 5513
Edwards, CA 93524-0001
Mailing address
30 Nightingale Ave Building 5513
Edwards, CA 93524-0001
Phone (661) 277-2872
Other practice location 1
1549 W 7th St
#104
Upland, CA 91786-6954
Phone (559) 300-7596
Other providers in Edwards, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.