Provider Demographics
NPI:1285820142
Name:PAN, ERIC CHUNG-REN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:CHUNG-REN
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 1:5955 MIRA MESA BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4304
Mailing Address - Country:US
Mailing Address - Phone:858-784-0500
Mailing Address - Fax:858-876-1529
Practice Address - Street 1:5955 MIRA MESA BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4304
Practice Address - Country:US
Practice Address - Phone:858-784-0500
Practice Address - Fax:858-876-1529
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101498207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine