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Individual

KUN PAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
125 PATERSON ST, NEW BRUNSWICK, NJ 08901-1962
(732) 235-8887
Mailing address
769 58TH ST, BROOKLYN, NY 11220-3916
(646) 597-3055

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA11540400
NJ
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
9140860054
AETNA
WV
Enumeration date
03/26/2019
Last updated
11/16/2022
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