Provider Demographics
NPI:1972287332
Name:HONGYING PAN DDS PHD PLLC
Entity type:Organization
Organization Name:HONGYING PAN DDS PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HONGYING
Authorized Official - Middle Name:
Authorized Official - Last Name:PAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-806-6652
Mailing Address - Street 1:22526 SE 64TH PL STE 110
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5368
Mailing Address - Country:US
Mailing Address - Phone:425-427-1850
Mailing Address - Fax:
Practice Address - Street 1:22526 SE 64TH PL STE 110
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5368
Practice Address - Country:US
Practice Address - Phone:425-427-1850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty