Healthcare Provider Details

I. General information

NPI: 1841515509
Provider Name (Legal Business Name): CHRIS WEI-SEN PAN MD. MBA. MS.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2699 ATLANTIC AVE
LONG BEACH CA
90806-2710
US

IV. Provider business mailing address

101 THE CITY DR S BLDG 25
ORANGE CA
92868-3201
US

V. Phone/Fax

Practice location:
  • Phone: 714-389-1828
  • Fax:
Mailing address:
  • Phone: 714-456-6699
  • Fax: 855-209-8413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA120568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: