Provider Demographics
NPI:1497806871
Name:PAN, ANNIE YONGMEI (LAC)
Entity Type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:YONGMEI
Last Name:PAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12394 BRASSICA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4126
Mailing Address - Country:US
Mailing Address - Phone:619-297-0446
Mailing Address - Fax:619-297-2628
Practice Address - Street 1:2841 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2928
Practice Address - Country:US
Practice Address - Phone:619-297-0446
Practice Address - Fax:619-297-2628
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5451171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist