Provider Demographics
NPI:1710234612
Name:PAN, ZICHANG (DDS MS)
Entity Type:Individual
Prefix:MS
First Name:ZICHANG
Middle Name:
Last Name:PAN
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39560 STEVENSON PL STE 220
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3074
Mailing Address - Country:US
Mailing Address - Phone:510-818-0182
Mailing Address - Fax:510-818-0313
Practice Address - Street 1:39560 STEVENSON PL STE 220
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-3074
Practice Address - Country:US
Practice Address - Phone:510-818-0182
Practice Address - Fax:510-818-0313
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist