Provider Demographics
NPI:1609003961
Name:PAN, CHUAN-JU GWENDOLYN (MD)
Entity Type:Individual
Prefix:
First Name:CHUAN-JU
Middle Name:GWENDOLYN
Last Name:PAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W LA VETA AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4300
Mailing Address - Country:US
Mailing Address - Phone:714-541-6622
Mailing Address - Fax:714-541-0531
Practice Address - Street 1:1010 W LA VETA AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4300
Practice Address - Country:US
Practice Address - Phone:714-541-6622
Practice Address - Fax:714-541-0531
Is Sole Proprietor?:No
Enumeration Date:2009-06-14
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110998207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW12156OtherPTAN