Provider Demographics
NPI:1649390717
Name:ZHAO YANG PAN M.D. INC
Entity Type:Organization
Organization Name:ZHAO YANG PAN M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:ZHAO YANG
Authorized Official - Middle Name:
Authorized Official - Last Name:PAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-617-7673
Mailing Address - Street 1:652 N BROADWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2802
Mailing Address - Country:US
Mailing Address - Phone:213-617-7673
Mailing Address - Fax:213-626-2168
Practice Address - Street 1:652 N BROADWAY
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2802
Practice Address - Country:US
Practice Address - Phone:213-617-7673
Practice Address - Fax:213-626-2168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA055081208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A550810Medicaid
CA00A550810Medicaid
CAA55081Medicare ID - Type Unspecified