Provider Demographics
NPI:1518113992
Name:PAN, JANE CHI-CHUN (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:CHI-CHUN
Last Name:PAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHI
Other - Middle Name:CHUN
Other - Last Name:PAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:530 LAKEHURST RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8063
Mailing Address - Country:US
Mailing Address - Phone:732-341-4733
Mailing Address - Fax:732-341-2794
Practice Address - Street 1:530 LAKEHURST RD
Practice Address - Street 2:SUITE 206
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8063
Practice Address - Country:US
Practice Address - Phone:732-341-4733
Practice Address - Fax:732-341-2794
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09541900207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNOTH000Medicare UPIN
TN3041798Medicare PIN