Provider Demographics
NPI:1225666928
Name:PAN, WENTAO ABRAM (MD)
Entity type:Individual
Prefix:
First Name:WENTAO
Middle Name:ABRAM
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 1:18225 HALE AVE
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-3547
Mailing Address - Country:US
Mailing Address - Phone:408-465-8280
Mailing Address - Fax:
Practice Address - Street 1:9343 TECH CENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2592
Practice Address - Country:US
Practice Address - Phone:916-457-3129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-29
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1840372084P0800X
CA40442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry