Provider Demographics
NPI:1710293956
Name:PAN, KURT X
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:X
Last Name:PAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:XINGKUI
Other - Middle Name:KURT
Other - Last Name:PAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:4521 FIREWHEEL DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3970
Mailing Address - Country:US
Mailing Address - Phone:972-491-7908
Mailing Address - Fax:972-767-1820
Practice Address - Street 1:4521 FIREWHEEL DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3970
Practice Address - Country:US
Practice Address - Phone:972-491-7908
Practice Address - Fax:972-767-1820
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107800171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor