Provider Demographics
NPI:1326554734
Name:PAN, YONGZHI
Entity Type:Individual
Prefix:
First Name:YONGZHI
Middle Name:
Last Name:PAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27317 N 51ST GLN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-7460
Mailing Address - Country:US
Mailing Address - Phone:602-300-7913
Mailing Address - Fax:
Practice Address - Street 1:2730 W AGUA FRIA FWY
Practice Address - Street 2:SUITE 200 OFFICE E-20
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-7201
Practice Address - Country:US
Practice Address - Phone:602-300-7913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1057171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty