Provider Demographics
NPI:1811334220
Name:PAN, WILLY Y (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLY
Middle Name:Y
Last Name:PAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10251 TORRE AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2186
Mailing Address - Country:US
Mailing Address - Phone:408-996-7001
Mailing Address - Fax:408-996-7017
Practice Address - Street 1:10251 TORRE AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2186
Practice Address - Country:US
Practice Address - Phone:408-996-7001
Practice Address - Fax:408-996-7017
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA469181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice