Active NPI
Jui Ray Pan, D.D.S.
- General Practice Dentistry
- West Covina, CA
National Provider Identifier
1710049341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 44350
- Practice address
- 2672 E Garvey Ave S
West Covina, CA 91791-2113 - Phone
- (626) 858-6988
- NPI assigned
- Dec 13, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 44350 | CA | Primary |
Addresses
Primary practice location
2672 E Garvey Ave S
West Covina, CA 91791-2113
Mailing address
2672 East Garvey Avenue South
West Covina, CA 91791
Phone (626) 858-6988
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 |
|---|---|---|---|
| 44350 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710049341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2672 EAST GARVEY AVENUE SOUTH",
"city": "WEST COVINA",
"state": "CA",
"postal_code": "91791",
"telephone_number": "626-858-6988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2672 E GARVEY AVE S",
"city": "WEST COVINA",
"state": "CA",
"postal_code": "917912113",
"telephone_number": "626-858-6988"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAN",
"first_name": "JUI",
"middle_name": "RAY",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "44350",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Covina, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.