Provider Demographics
NPI:1235693920
Name:PAN, CHAO HONG
Entity Type:Individual
Prefix:
First Name:CHAO HONG
Middle Name:
Last Name:PAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2723 CROW CANYON RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1635
Mailing Address - Country:US
Mailing Address - Phone:925-314-6668
Mailing Address - Fax:
Practice Address - Street 1:2723 CROW CANYON RD STE 105
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1635
Practice Address - Country:US
Practice Address - Phone:925-314-6668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-26
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18388171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist