Provider Demographics
NPI:1922057587
Name:PAN, PATRICK T (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:T
Last Name:PAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:351 HOSPITAL RD
Mailing Address - Street 2:SUITE 407
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3506
Mailing Address - Country:US
Mailing Address - Phone:949-200-7307
Mailing Address - Fax:949-200-7456
Practice Address - Street 1:351 HOSPITAL RD
Practice Address - Street 2:SUITE 407
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3506
Practice Address - Country:US
Practice Address - Phone:949-200-7307
Practice Address - Fax:949-200-7456
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2017-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA61505207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A615050Medicaid
CAA61505Medicare ID - Type UnspecifiedMEDICARE PROVIDER #