Provider Demographics
NPI:1396015269
Name:PAN, XIU FEN (LAC)
Entity Type:Individual
Prefix:MS
First Name:XIU FEN
Middle Name:
Last Name:PAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:PAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:1930 MAGELLAN DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2636
Mailing Address - Country:US
Mailing Address - Phone:415-349-1945
Mailing Address - Fax:
Practice Address - Street 1:1840 SAN MIGUEL DR SUITE 203
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596
Practice Address - Country:US
Practice Address - Phone:925-391-0066
Practice Address - Fax:925-940-9523
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14378171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist