Provider Demographics
NPI:1972941219
Name:PAN, KRISTINA MEL LEE
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MEL LEE
Last Name:PAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 RAYCROFT ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-8717
Mailing Address - Country:US
Mailing Address - Phone:617-592-1900
Mailing Address - Fax:617-479-4260
Practice Address - Street 1:83 RAYCROFT ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-8717
Practice Address - Country:US
Practice Address - Phone:617-592-1900
Practice Address - Fax:617-479-4260
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-09
Last Update Date:2013-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist