Provider Demographics
NPI:1275573040
Name:PAN, KAREN (L AC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:PAN
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7452 HEALIS PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2275
Mailing Address - Country:US
Mailing Address - Phone:858-538-9347
Mailing Address - Fax:
Practice Address - Street 1:7825 HIGHLAND VILLAGE PL
Practice Address - Street 2:SUITE #450
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-5182
Practice Address - Country:US
Practice Address - Phone:858-231-4405
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212021171100000X
CA10055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist