Provider Demographics
NPI:1396189114
Name:ANTHONY S. PAN, D.M.D., INC.
Entity Type:Organization
Organization Name:ANTHONY S. PAN, D.M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:SUNG-EN
Authorized Official - Last Name:PAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:626-350-0588
Mailing Address - Street 1:9328 GARVEY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOUTH EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-4602
Mailing Address - Country:US
Mailing Address - Phone:626-350-0588
Mailing Address - Fax:626-350-0989
Practice Address - Street 1:9328 GARVEY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SOUTH EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-4602
Practice Address - Country:US
Practice Address - Phone:626-350-0588
Practice Address - Fax:626-350-0989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA595481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty