Healthcare Provider Details

I. General information

NPI: 1255952958
Provider Name (Legal Business Name): KRISTEN SHIAO-YU PAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E NICOLLET BLVD STE 330
BURNSVILLE MN
55337-4594
US

IV. Provider business mailing address

303 E NICOLLET BLVD STE 330
BURNSVILLE MN
55337-4594
US

V. Phone/Fax

Practice location:
  • Phone: 952-435-0177
  • Fax:
Mailing address:
  • Phone: 952-435-0177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number80147
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: