Provider Demographics
NPI:1720169030
Name:PAN, KAREN H (LAC)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:H
Last Name:PAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1671 CREEKSIDE DR
Mailing Address - Street 2:103
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3890
Mailing Address - Country:US
Mailing Address - Phone:916-984-6608
Mailing Address - Fax:916-984-3809
Practice Address - Street 1:1671 CREEKSIDE DR
Practice Address - Street 2:103
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3890
Practice Address - Country:US
Practice Address - Phone:916-984-6608
Practice Address - Fax:916-984-3809
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8197171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist