Provider Demographics
NPI:1700637618
Name:PAN, YAOJI
Entity Type:Individual
Prefix:
First Name:YAOJI
Middle Name:
Last Name:PAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22727 HIGHWAY 99 STE 205
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8381
Mailing Address - Country:US
Mailing Address - Phone:425-471-4083
Mailing Address - Fax:425-577-6509
Practice Address - Street 1:22727 HIGHWAY 99 STE 205
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8381
Practice Address - Country:US
Practice Address - Phone:425-471-4083
Practice Address - Fax:425-577-6509
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61438831174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist