Provider Demographics
NPI:1922882943
Name:PAN, JIAO (LAC)
Entity Type:Individual
Prefix:
First Name:JIAO
Middle Name:
Last Name:PAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 NADINE DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1724
Mailing Address - Country:US
Mailing Address - Phone:972-741-7781
Mailing Address - Fax:
Practice Address - Street 1:3920 WILLIAMS RD UNIT B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-2745
Practice Address - Country:US
Practice Address - Phone:972-741-7781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19830171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist