Provider Demographics
NPI:1295239622
Name:PAN, EUNYUNG CHRISTINE (OTR/L)
Entity type:Individual
Prefix:
First Name:EUNYUNG
Middle Name:CHRISTINE
Last Name:PAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 KEYSTONE AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-7154
Mailing Address - Country:US
Mailing Address - Phone:201-450-8527
Mailing Address - Fax:
Practice Address - Street 1:3900 FREEDOM CIR STE 201
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1222
Practice Address - Country:US
Practice Address - Phone:408-202-7974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17088225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist