Healthcare Provider Details

I. General information

NPI: 1205025178
Provider Name (Legal Business Name): PAN AND HSU PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 ATLANTIC AVE STE 605
LONG BEACH CA
90813-3414
US

IV. Provider business mailing address

1045 ATLANTIC AVE STE 605
LONG BEACH CA
90813-3414
US

V. Phone/Fax

Practice location:
  • Phone: 562-901-6767
  • Fax: 562-901-6777
Mailing address:
  • Phone: 562-901-6767
  • Fax: 562-901-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA43079
License Number StateCA

VIII. Authorized Official

Name: DR. JENNY PAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-345-8729