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General NPI Number Information
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NPI Number | 1750721049
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Entity Type | Individual
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Provider Name | VIVIAN PAN C.G.C.
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Gender | Female
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Dates
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Enumeration Date | 07/01/2013
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 818 S WOLCOTT AVE
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City | CHICAGO
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State | IL
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Zip | 60612-3702
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Country | US
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Telephone | 312-413-4478
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Fax | 312-996-5760
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Provider Business Mailing Address
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Address Line | 4525 N WESTERN AVE APT 4A
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City | CHICAGO
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State | IL
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Zip | 60625-6933
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Country | US
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Telephone | 312-952-2584
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Fax | 312-996-5760
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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 | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number | 74000062A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number | 247000040
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License Number State | IL
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