Active NPI
Li Ju Pan
- Registered Nurse
- Victorville, CA
National Provider Identifier
1447700315
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 542750
- Practice address
- 12625 Hesperia Rd
Victorville, CA 92395-7720 - Phone
- (760) 995-8300
- Fax
- (760) 995-2356
- NPI assigned
- Oct 4, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 542750 | CA | Primary |
Addresses
Primary practice location
12625 Hesperia Rd
Victorville, CA 92395-7720
Mailing address
12625 Hesperia Rd
Victorville, CA 92395-7720
Phone (760) 995-8300
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 |
|---|---|---|---|
| 542750 | CA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477440000000",
"number": "1447700315",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12625 HESPERIA RD",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "923957720",
"telephone_number": "760-995-8300",
"fax_number": "760-995-2356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12625 HESPERIA RD",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "923957720",
"telephone_number": "760-995-8300",
"fax_number": "760-995-2356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAN",
"first_name": "LI JU",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-04",
"last_updated": "2016-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "CA",
"license": "542750",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Victorville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.