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NPI Code Detail

MEDICARE: WANG PAN

MEDICARE: WANG PAN
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
1103K00000XBehavior Analyst1-22-60108CA

General Provider Information

NPI Number : 1972199073
Entity Type Code : Individual
Provider Name (Legal Business Name) : WANG PAN
Provider Business Mailing Address
First Line : 99 PASADENA AVE STE 10C
Second Line :
City : SOUTH PASADENA
State : CA
Zip : 91030-6142
Country : US
Telephone Number : 626-219-9258
Fax Number :
Provider Business Practice Location Address
First Line : 99 PASADENA AVE STE 10C
Second Line :
City : SOUTH PASADENA
State : CA
Zip : 91030-6142
Country : US
Telephone Number : 323-341-5580
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2020
Last Update Date : 09/02/2022

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Directions to “ WANG PAN ” Practice Location

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