Provider Demographics
NPI:1376745380
Name:PAN, LIN (LIC ACUPUNCTURIST)
Entity Type:Individual
Prefix:MRS
First Name:LIN
Middle Name:
Last Name:PAN
Suffix:
Gender:F
Credentials:LIC ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3083 BORGATA WAY
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-5434
Mailing Address - Country:US
Mailing Address - Phone:916-933-0638
Mailing Address - Fax:
Practice Address - Street 1:6049 DOUGLAS BLVD
Practice Address - Street 2:SUITE 22
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6284
Practice Address - Country:US
Practice Address - Phone:916-247-8717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10224171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 10224OtherACUPUNCTURE LICENSE #