Healthcare Provider Details

I. General information

NPI: 1174740005
Provider Name (Legal Business Name): JOHN J. PAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 HARRISON AVE
BOSTON MA
02118-2905
US

IV. Provider business mailing address

960 MASSACHUSETTS AVE FL 2
BOSTON MA
02118-2690
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-6610
  • Fax: 617-638-6616
Mailing address:
  • Phone: 617-414-5405
  • Fax: 617-414-6038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA89915
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number42588
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number231127
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: