Provider Demographics
NPI:1215054663
Name:PAHANG, MARK GREGORY (PT, DPT, LMT)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:GREGORY
Last Name:PAHANG
Suffix:
Gender:M
Credentials:PT, DPT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 970116
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-0116
Mailing Address - Country:US
Mailing Address - Phone:808-277-8372
Mailing Address - Fax:808-680-0019
Practice Address - Street 1:91-1488 PUKANALA ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-4678
Practice Address - Country:US
Practice Address - Phone:808-277-8372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2023-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-9599225700000X
HIPT-19392251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI54142603OtherALOHA CARE
HI473883OtherOHANA HEALTH PLAN
HI400000100OtherOWCP
HI541426Medicaid
HI00F0238557OtherHMSA
HI00G0238555OtherHMSA SECOND LOCATION
HI473883OtherOHANA HEALTH PLAN