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General NPI Number Information
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NPI Number | 1023133303
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Entity Type | Organization
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Legal Business Name | WILLY Y PAN DDS INC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 09/21/2010
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Provider Practice Location Address
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Address Line | 10251 TORRE AVE SUITE 208
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City | CUPERTINO
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State | CA
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Zip | 95014
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Country | US
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Telephone | 408-996-7001
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Fax | 408-996-7017
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Provider Business Mailing Address
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Address Line | 10251 TORRE AVE SUITE 208
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City | CUPERTINO
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State | CA
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Zip | 95014
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Country | US
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Telephone | 408-996-7001
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Fax | 408-996-7017
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Authorized Official
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Title or Position | DENTIST PRESIDENT
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Name | DR. WILLY YU CHENG PAN
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Credential | DDS
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Telephone | 408-996-7001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 46918
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License Number State | CA
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