Provider Demographics
NPI:1700893427
Name:PAN, LUNG HSIUNG (MD)
Entity Type:Individual
Prefix:
First Name:LUNG HSIUNG
Middle Name:
Last Name:PAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MOUNTAIN BROOK DR
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850
Mailing Address - Country:US
Mailing Address - Phone:607-757-0172
Mailing Address - Fax:607-757-0172
Practice Address - Street 1:8 MOUNTAIN BROOK DR
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850
Practice Address - Country:US
Practice Address - Phone:607-757-0172
Practice Address - Fax:607-757-0172
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123199207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00575860Medicaid
NY00575860Medicaid
C58523Medicare UPIN