Provider Demographics
NPI:1477136505
Name:PAN, KATHERINE LEE (DO)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LEE
Last Name:PAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 AUAHI ST APT 1701
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4966
Mailing Address - Country:US
Mailing Address - Phone:480-717-0309
Mailing Address - Fax:
Practice Address - Street 1:1108 AUAHI ST APT 1701
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4966
Practice Address - Country:US
Practice Address - Phone:480-717-0309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS20625208D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice