Provider Demographics
NPI:1114265949
Name:PAN, WAYNE (MD, PHD, MBA)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:
Last Name:PAN
Suffix:
Gender:M
Credentials:MD, PHD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 VALLEJO ST APT D
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2136
Mailing Address - Country:US
Mailing Address - Phone:650-922-8131
Mailing Address - Fax:
Practice Address - Street 1:5901 VALLEJO ST APT D
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-2136
Practice Address - Country:US
Practice Address - Phone:650-922-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84772207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery