Provider Demographics
NPI:1710513684
Name:PAN, VINCENT (DO)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:PAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 W LA VETA AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3930
Mailing Address - Country:US
Mailing Address - Phone:714-639-2600
Mailing Address - Fax:
Practice Address - Street 1:845 W LA VETA AVE STE 108
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3930
Practice Address - Country:US
Practice Address - Phone:714-639-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A19710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine