Individual
TIANLI PAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20103 LAKE CHABOT RD, CASTRO VALLEY, CA 94546-5305
(510) 727-3256
(510) 727-3107
Mailing address
3687 MT DIABLO BLVD STE 200, LAFAYETTE, CA 94549-3746
(916) 854-6975
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A91025
CA
208M00000X
Hospitalist Physician
Primary
A910225
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A91025
STATE LICENSE
CA
Enumeration date
04/27/2007
Last updated
07/21/2022
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