Provider Demographics
NPI:1134162951
Name:LAN, VICTOR SUNGSHU (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:SUNGSHU
Last Name:LAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2255 PHILADELPHIA STREET
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701
Mailing Address - Country:US
Mailing Address - Phone:724-349-1616
Mailing Address - Fax:724-349-4834
Practice Address - Street 1:2255 PHILADELPHIA STREET
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701
Practice Address - Country:US
Practice Address - Phone:724-349-1616
Practice Address - Fax:724-349-4834
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037195L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007231840001Medicaid
PA0007231840004Medicaid
C27726Medicare UPIN
PA0007231840004Medicaid