Healthcare Provider Details

I. General information

NPI: 1275573040
Provider Name (Legal Business Name): KAREN PAN L. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7825 HIGHLAND VILLAGE PL SUITE #450
SAN DIEGO CA
92129-5182
US

IV. Provider business mailing address

7452 HEALIS PL
SAN DIEGO CA
92129-2275
US

V. Phone/Fax

Practice location:
  • Phone: 858-231-4405
  • Fax:
Mailing address:
  • Phone: 858-538-9347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number212021
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number10055
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: