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NPI Code Detail

MEDICARE: DR. JENNY SUN PAN DMD

MEDICARE: DR. JENNY SUN PAN DMD
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
1122300000XDentist53344CA

General Provider Information

NPI Number : 1245369263
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNY SUN PAN DMD
Provider Business Mailing Address
First Line : 517 WORKMAN AVE
Second Line :
City : ARCADIA
State : CA
Zip : 91007-8456
Country : US
Telephone Number : 626-808-2300
Fax Number :
Provider Business Practice Location Address
First Line : 711 W FLORENCE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90044-6105
Country : US
Telephone Number : 323-789-5610
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 07/08/2020

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