MEDICARE: ANTHONY S. PAN, D.M.D., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	59548	CA

General Provider Information

NPI Number	:	1396189114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONY S. PAN, D.M.D., INC.

Provider Business Mailing Address
First Line	:	9328 GARVEY AVE
Second Line	:	SUITE A
City	:	SOUTH EL MONTE
State	:	CA
Zip	:	91733-4602
Country	:	US
Telephone Number	:	626-350-0588
Fax Number	:	626-350-0989

Provider Business Practice Location Address
First Line	:	9328 GARVEY AVE
Second Line	:	SUITE A
City	:	SOUTH EL MONTE
State	:	CA
Zip	:	91733-4602
Country	:	US
Telephone Number	:	626-350-0588
Fax Number	:	626-350-0989

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANTHONY SUNG-EN PAN
Credential	:	D.M.D.
Telephone Number	:	626-350-0588

Provider Enumeration Date	:	04/23/2013
Last Update Date	:	04/23/2013

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