Provider Demographics
NPI:1245369263
Name:PAN, JENNY SUN (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:SUN
Last Name:PAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JENNY
Other - Middle Name:SUN
Other - Last Name:TJAHJONO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:517 WORKMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-8456
Mailing Address - Country:US
Mailing Address - Phone:626-808-2300
Mailing Address - Fax:
Practice Address - Street 1:711 W FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-6105
Practice Address - Country:US
Practice Address - Phone:323-789-5610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53344122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist