Provider Demographics
NPI:1932316510
Name:PAN & PAN MEDICAL GROUP A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PAN & PAN MEDICAL GROUP A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KWEI-MIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-540-0301
Mailing Address - Street 1:2621 S BRISTOL ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5766
Mailing Address - Country:US
Mailing Address - Phone:714-540-0301
Mailing Address - Fax:714-540-0311
Practice Address - Street 1:2621 S BRISTOL ST
Practice Address - Street 2:SUITE 208
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5766
Practice Address - Country:US
Practice Address - Phone:714-540-0301
Practice Address - Fax:714-540-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43080208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEIN