Individual
DR. WEN S FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Contact information
Practice address
2039 FOREST AVE STE 306, SAN JOSE, CA 95128-4830
(408) 298-7775
Mailing address
1235 BROCKTON AVE, #206, LOS ANGELES, CA 90025-1344
(310) 770-5498
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
52603
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
52603
CA
Other
Enumeration date
04/11/2007
Last updated
05/03/2009
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