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General NPI Number Information
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NPI Number | 1922321348
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Entity Type | Organization
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Legal Business Name | JEFF J. S. PAN, MD, PC
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Dates
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Enumeration Date | 03/12/2010
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Last Update Date | 03/12/2010
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Provider Practice Location Address
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Address Line | 6408 SEVEN CORNERS PL STE L
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City | FALLS CHURCH
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State | VA
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Zip | 22044-2011
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Country | US
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Telephone | 703-534-0414
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Fax | 703-534-7347
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Provider Business Mailing Address
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Address Line | 6408 SEVEN CORNERS PL SUITE L
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City | FALLS CHURCH
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State | VA
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Zip | 22044-2011
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Country | US
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Telephone | 703-534-0414
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Fax | 703-534-7347
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFF J. S. PAN
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Credential | MD
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Telephone | 703-534-0414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | VA0101041614
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License Number State | VA
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