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General NPI Number Information
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NPI Number | 1518374131
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Entity Type | Individual
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Provider Name | XINYUE PAN MD
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Gender | Female
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 1650 GRAND CONCOURSE
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City | BRONX
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State | NY
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Zip | 10457-7606
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Country | US
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Telephone | 718-992-7669
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Fax |
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Provider Business Mailing Address
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Address Line | 1276 FULTON AVE
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City | BRONX
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State | NY
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Zip | 10456-3402
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Country | US
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Telephone | 718-992-7669
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301106120
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 311623
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License Number State | NY
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