Provider Demographics
NPI:1841394343
Name:PAN, SIMON TIN YEANG (DPM)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:TIN YEANG
Last Name:PAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9896 BELLAIRE BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3496
Mailing Address - Country:US
Mailing Address - Phone:713-270-8682
Mailing Address - Fax:713-270-8990
Practice Address - Street 1:9896 BELLAIRE BLVD STE H
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3496
Practice Address - Country:US
Practice Address - Phone:713-270-8682
Practice Address - Fax:713-270-8990
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1402213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018608201Medicaid
TX018608201Medicaid
TX4019020001Medicare NSC
U71740Medicare UPIN