Provider Demographics
NPI:1225193964
Name:PAN, ZHAOYANG (MD)
Entity Type:Individual
Prefix:DR
First Name:ZHAOYANG
Middle Name:
Last Name:PAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 N BROADWAY # A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2802
Mailing Address - Country:US
Mailing Address - Phone:213-617-7673
Mailing Address - Fax:213-626-2168
Practice Address - Street 1:652 N BROADWAY # A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2802
Practice Address - Country:US
Practice Address - Phone:213-617-7673
Practice Address - Fax:213-626-2168
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA055081208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A550810Medicaid
CA00A550810Medicaid
CAA55081Medicare ID - Type Unspecified