Provider Demographics
NPI:1346688538
Name:PAN, HARRY SEBASTIAN (DO)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:SEBASTIAN
Last Name:PAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3097 E WARM SPRINGS RD STE 400
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3757
Mailing Address - Country:US
Mailing Address - Phone:702-790-2211
Mailing Address - Fax:
Practice Address - Street 1:3097 E WARM SPRINGS RD STE 400
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3757
Practice Address - Country:US
Practice Address - Phone:702-790-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSL0964207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDO2007OtherMEDICAL LICENSE