Healthcare Provider Details

I. General information

NPI: 1932316510
Provider Name (Legal Business Name): PAN & PAN MEDICAL GROUP A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 S BRISTOL ST SUITE 208
SANTA ANA CA
92704-5766
US

IV. Provider business mailing address

2621 S BRISTOL ST SUITE 208
SANTA ANA CA
92704-5766
US

V. Phone/Fax

Practice location:
  • Phone: 714-540-0301
  • Fax: 714-540-0311
Mailing address:
  • Phone: 714-540-0301
  • Fax: 714-540-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA43080
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA43080
License Number StateCA

VIII. Authorized Official

Name: KWEI-MIN PAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-540-0301