Healthcare Provider Details

I. General information

NPI: 1861020117
Provider Name (Legal Business Name): BO-CHIH PAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SHAWN PAN

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

150 HARVESTER DR STE 300
BURR RIDGE IL
60527-5965
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA209056
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036169137
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: