Provider Demographics
NPI:1821345968
Name:PAN, YU (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:YU
Middle Name:
Last Name:PAN
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 UNIVERSITY AVE W
Mailing Address - Street 2:UNIT 102
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1917
Mailing Address - Country:US
Mailing Address - Phone:612-618-3693
Mailing Address - Fax:
Practice Address - Street 1:5101 VERNON AVE S
Practice Address - Street 2:SUITE 502
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-2172
Practice Address - Country:US
Practice Address - Phone:952-926-3747
Practice Address - Fax:952-926-0701
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND128001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics