MEDICARE: DR. WAYNE PAN MD, PHD, MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0106X	Orthopaedic Hand Surgery Physician	G84772	CA

General Provider Information

NPI Number	:	1114265949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE PAN MD, PHD, MBA

Provider Business Mailing Address
First Line	:	5901 VALLEJO ST APT D
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94608-2136
Country	:	US
Telephone Number	:	650-922-8131
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 VALLEJO ST APT D
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94608-2136
Country	:	US
Telephone Number	:	650-922-8131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2013
Last Update Date	:	09/28/2021

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