Provider Demographics
NPI:1477698231
Name:NISCO, YEN PAN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:YEN
Middle Name:PAN
Last Name:NISCO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MINERAL KING #203
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291
Mailing Address - Country:US
Mailing Address - Phone:559-732-7906
Mailing Address - Fax:559-732-7903
Practice Address - Street 1:300 E MINERAL KING #203
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291
Practice Address - Country:US
Practice Address - Phone:559-732-7906
Practice Address - Fax:559-732-7903
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC426891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB426892OtherDELTA DENTAL HEALTHY FAMI
CA1634033OtherUNITED CONCORDIA