Individual
QUEENY PAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 S PRESTON ST RM 305, LOUISVILLE, KY 40202-1702
(917) 796-1183
Mailing address
500 S PRESTON ST RM 305, LOUISVILLE, KY 40202-1702
(917) 796-1183
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MA12341200
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
254617206
DRIVERS LICENSE
NY
Enumeration date
04/06/2018
Last updated
07/29/2024
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