Individual
GARY FAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1720 E CESAR E CHAVEZ AVE, LOS ANGELES, CA 90033-2414
(562) 407-2080
Mailing address
PO BOX 4259, CERRITOS, CA 90703-4259
(562) 407-2080
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A87120
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A87120
—
CA
Enumeration date
08/05/2006
Last updated
07/08/2007
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