Healthcare Provider Details

I. General information

NPI: 1972206936
Provider Name (Legal Business Name): HAI PAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 N HENDERSON RD STE 310
KING OF PRUSSIA PA
19406-2155
US

IV. Provider business mailing address

170 N HENDERSON RD STE 310
KING OF PRUSSIA PA
19406-2155
US

V. Phone/Fax

Practice location:
  • Phone: 267-348-4139
  • Fax: 610-523-5982
Mailing address:
  • Phone: 267-348-4139
  • Fax: 610-523-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD493865
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: