1932316510 NPI number — PAN & PAN MEDICAL GROUP A PROFESSIONAL MEDICAL CORPORATION

Table of content: DR. EDGAR CECIL FEARNOW III M.D. (NPI 1174526297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932316510 NPI number — PAN & PAN MEDICAL GROUP A PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAN & PAN MEDICAL GROUP A PROFESSIONAL MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932316510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2621 S BRISTOL ST
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92704-5766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-540-0301
Provider Business Mailing Address Fax Number:
714-540-0311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2621 S BRISTOL ST
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92704-5766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-540-0301
Provider Business Practice Location Address Fax Number:
714-540-0311
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PAN
Authorized Official First Name:
KWEI-MIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-540-0301

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  A43080 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2086S0129X , with the licence number: A43080 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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