Provider Demographics
NPI:1174716641
Name:PAN, YU (PHD)
Entity type:Individual
Prefix:
First Name:YU
Middle Name:
Last Name:PAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:Y
Other - Last Name:PAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:39470 ALBANY CMN APT D
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2390
Mailing Address - Country:US
Mailing Address - Phone:626-315-6083
Mailing Address - Fax:626-284-4202
Practice Address - Street 1:943 S ATLANTIC BLVD STE 221
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1066
Practice Address - Country:US
Practice Address - Phone:626-284-4202
Practice Address - Fax:626-284-4202
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23449103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADF854AMedicare UPIN