Provider Demographics
NPI:1023251733
Name:PAN, ANNIE (LAC)
Entity type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:
Last Name:PAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:WEI
Other - Middle Name:QUN
Other - Last Name:PAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2723 CROW CANYON RD STE 211
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1583
Mailing Address - Country:US
Mailing Address - Phone:925-208-1363
Mailing Address - Fax:
Practice Address - Street 1:2723 CROW CANYON RD STE 211
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1583
Practice Address - Country:US
Practice Address - Phone:925-208-1363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12944171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist