# BENJERMIN FAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1669333167
- **Gender:** X

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 95031818 | CA | Yes |
| 363LP0200X | Pediatric Nurse Practitioner | 95031818 | CA | — |

## Other

- **Enumeration date:** 11/24/2025
- **Last updated:** 12/04/2025