Healthcare Provider Details

I. General information

NPI: 1295026417
Provider Name (Legal Business Name): GEORGE PAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 W OLYMPIC BLVD STE 502
LOS ANGELES CA
90064-1528
US

IV. Provider business mailing address

11500 W OLYMPIC BLVD STE 502
LOS ANGELES CA
90064-1528
US

V. Phone/Fax

Practice location:
  • Phone: 424-300-8217
  • Fax: 310-861-0087
Mailing address:
  • Phone: 424-300-8217
  • Fax: 310-861-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA132921
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA132921
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: