Healthcare Provider Details

I. General information

NPI: 1225666928
Provider Name (Legal Business Name): WENTAO ABRAM PAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY BLDG 651
MATHER CA
95655-4200
US

IV. Provider business mailing address

10535 HOSPITAL WAY
MATHER CA
95655-4200
US

V. Phone/Fax

Practice location:
  • Phone: 916-843-7000
  • Fax:
Mailing address:
  • Phone: 916-843-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA184037
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: