Provider Demographics
NPI:1982722476
Name:PAN, HONGJUN (LAC,)
Entity type:Individual
Prefix:
First Name:HONGJUN
Middle Name:
Last Name:PAN
Suffix:
Gender:M
Credentials:LAC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1538 SOUTH WINCHESTER BL
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128
Mailing Address - Country:US
Mailing Address - Phone:408-621-6760
Mailing Address - Fax:408-253-2869
Practice Address - Street 1:1538 S WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4336
Practice Address - Country:US
Practice Address - Phone:408-621-6760
Practice Address - Fax:408-253-2869
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10903171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist