Provider Demographics
NPI:1609092683
Name:PAN, NING
Entity Type:Individual
Prefix:
First Name:NING
Middle Name:
Last Name:PAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 VALLEYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-1947
Mailing Address - Country:US
Mailing Address - Phone:415-218-4958
Mailing Address - Fax:650-872-2568
Practice Address - Street 1:2141 VALLEYWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-1947
Practice Address - Country:US
Practice Address - Phone:415-218-4958
Practice Address - Fax:650-872-2568
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 8817171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist