MEDICARE: MR. TUNG WEI PAN L.AC.

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	171100000X	Acupuncturist	AC 12012	CA

General Provider Information

NPI Number	:	1235310640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TUNG WEI PAN L.AC.

Provider Business Mailing Address
First Line	:	25 E HUNTINGTON DR # 103
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91006-3210
Country	:	US
Telephone Number	:	626-627-3586
Fax Number	:	360-937-6546

Provider Business Practice Location Address
First Line	:	25 E HUNTINGTON DR # 103
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91006-3210
Country	:	US
Telephone Number	:	626-627-3586
Fax Number	:	360-937-6546

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

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	11/14/2007

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