Healthcare Provider Details

I. General information

NPI: 1427298389
Provider Name (Legal Business Name): ETHAN Y PAN LICENCED ACUPUNCTURI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. YI PAN

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 CASTRO ST
MOUNTAIN VIEW CA
94041-2013
US

IV. Provider business mailing address

795 CASTRO ST
MOUNTAIN VIEW CA
94041-2013
US

V. Phone/Fax

Practice location:
  • Phone: 650-961-1688
  • Fax: 650-961-7466
Mailing address:
  • Phone: 650-961-1688
  • Fax: 650-961-7466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC12890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: