Provider Demographics
NPI:1023133303
Name:WILLY Y PAN DDS INC
Entity type:Organization
Organization Name:WILLY Y PAN DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLY
Authorized Official - Middle Name:YU CHENG
Authorized Official - Last Name:PAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-996-7001
Mailing Address - Street 1:10251 TORRE AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014
Mailing Address - Country:US
Mailing Address - Phone:408-996-7001
Mailing Address - Fax:408-996-7017
Practice Address - Street 1:10251 TORRE AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014
Practice Address - Country:US
Practice Address - Phone:408-996-7001
Practice Address - Fax:408-996-7017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46918122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty