Healthcare Provider Details

I. General information

NPI: 1952263477
Provider Name (Legal Business Name): WANCHUAN PAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9713 SANTA MONICA BLVD STE 201
BEVERLY HILLS CA
90210-4236
US

IV. Provider business mailing address

235 S SAN PEDRO ST APT 402
LOS ANGELES CA
90012-3566
US

V. Phone/Fax

Practice location:
  • Phone: 310-564-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: