Provider Demographics
NPI:1124098215
Name:PAN, HUAI C (MD)
Entity type:Individual
Prefix:
First Name:HUAI
Middle Name:C
Last Name:PAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 MACK RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5373
Mailing Address - Country:US
Mailing Address - Phone:513-874-0808
Mailing Address - Fax:
Practice Address - Street 1:2960 MACK RD
Practice Address - Street 2:SUITE 212
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5373
Practice Address - Country:US
Practice Address - Phone:513-874-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH41823208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0514392Medicare PIN
CO2354Medicare UPIN