MEDICARE: DR. SIMON S PAN

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	122300000X	Dentist	29545	CA

General Provider Information

NPI Number	:	1558316158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIMON S PAN

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

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/08/2007

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