Provider Demographics
NPI:1932181567
Name:PAN, RICHARD JD (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JD
Last Name:PAN
Suffix:
Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:2516 STOCKTON BLVD
Mailing Address - Street 2:UCD DEPARTMENT OF PEDIATRICS
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2208
Mailing Address - Country:US
Mailing Address - Phone:916-734-1518
Mailing Address - Fax:916-456-2236
Practice Address - Street 1:2516 STOCKTON BLVD
Practice Address - Street 2:UCD DEPARTMENT OF PEDIATRICS
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2208
Practice Address - Country:US
Practice Address - Phone:916-734-1518
Practice Address - Fax:916-456-2236
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG84883208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG84883OtherMEDICAL LICENSE
CA07108Medicare UPIN