MEDICARE: DR. ZHAOYANG PAN M.D.

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	208D00000X	General Practice Physician	A055081	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225193964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZHAOYANG PAN M.D.

Provider Business Mailing Address
First Line	:	652 N BROADWAY # A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-2802
Country	:	US
Telephone Number	:	213-617-7673
Fax Number	:	213-626-2168

Provider Business Practice Location Address
First Line	:	652 N BROADWAY # A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-2802
Country	:	US
Telephone Number	:	213-617-7673
Fax Number	:	213-626-2168

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

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	07/08/2007

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