Provider Demographics
NPI:1912932740
Name:PAN, DAVID (MD, FACC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PAN
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WESTLAKE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-0918
Mailing Address - Country:US
Mailing Address - Phone:714-544-0533
Mailing Address - Fax:714-838-2858
Practice Address - Street 1:1140 W LA VETA AVE
Practice Address - Street 2:SUITE 430
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4225
Practice Address - Country:US
Practice Address - Phone:714-543-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60454207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA60454OtherMEDICAL LICENSE
CABP5533624OtherDEA
CABP5533624OtherDEA
CAG61711Medicare UPIN
CAW13178Medicare ID - Type UnspecifiedFACILITY