Active NPI
John Vincent Pendon Pan
- Behavior Technician
- Salem, OR
National Provider Identifier
1104499896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- Y4606089
- Practice address
- 3400 State St Ste G750
Salem, OR 97301-7012 - Phone
- (818) 345-2345
- NPI assigned
- Jul 20, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Y4606089 | CA | Primary |
Addresses
Primary practice location
3400 State St Ste G750
Salem, OR 97301-7012
Mailing address
21600 Oxnard St Ste 1800
Woodland Hills, CA 91367-7807
Phone (838) 345-2345
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| Y4606089 | CA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626739200000",
"number": "1104499896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21600 OXNARD ST STE 1800",
"city": "WOODLAND HILLS",
"state": "CA",
"postal_code": "913677807",
"telephone_number": "838-345-2345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 STATE ST STE G750",
"city": "SALEM",
"state": "OR",
"postal_code": "973017012",
"telephone_number": "818-345-2345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAN",
"first_name": "JOHN VINCENT",
"middle_name": "PENDON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-20",
"last_updated": "2021-07-20",
"certification_date": "2021-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "Y4606089",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.