Provider Demographics
NPI:1437261138
Name:PAN, JEFF JEN SHIANG (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:JEN SHIANG
Last Name:PAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6408 SEVEN CORNERS PL
Mailing Address - Street 2:SUITE L
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2011
Mailing Address - Country:US
Mailing Address - Phone:703-534-0414
Mailing Address - Fax:703-534-7347
Practice Address - Street 1:6408 SEVEN CORNERS PL
Practice Address - Street 2:SUITE L
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2011
Practice Address - Country:US
Practice Address - Phone:703-534-0414
Practice Address - Fax:703-534-7347
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041614208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
529425Medicare ID - Type Unspecified
VAE11542Medicare UPIN