Provider Demographics
NPI:1629465158
Name:GUAN, DANDAN (PAC)
Entity Type:Individual
Prefix:
First Name:DANDAN
Middle Name:
Last Name:GUAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5408 8TH AVE # 3F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3230
Mailing Address - Country:US
Mailing Address - Phone:718-864-0163
Mailing Address - Fax:
Practice Address - Street 1:132 BOWERY FRNT 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4297
Practice Address - Country:US
Practice Address - Phone:718-864-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018578363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical