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NPI Code Detail

MEDICARE: DR. KENNY PAN DDS

MEDICARE: DR. KENNY PAN DDS
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
11223G0001XGeneral Practice Dentistry063227NY

General Provider Information

NPI Number : 1407591092
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNY PAN DDS
Provider Business Mailing Address
First Line : 1580 ELMWOOD AVE STE 10
Second Line :
City : ROCHESTER
State : NY
Zip : 14620-3620
Country : US
Telephone Number : 646-267-9419
Fax Number :
Provider Business Practice Location Address
First Line : 1580 ELMWOOD AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14620-3620
Country : US
Telephone Number : 646-267-9419
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2022
Last Update Date : 04/07/2026

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