Individual
DR. FANG FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, PHD
Contact information
Practice address
1500 DUARTE RD, DUARTE, CA 91010-3012
(626) 256-4673
Mailing address
PO BOX 512185, LOS ANGELES, CA 90051-0185
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
01-28862
KS
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
C170975
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100421410A
—
KS
05
—
205840705
—
MO
01
—
31139011
BCBS KANSAS CITY
MS
01
—
431580
FIRSTGUARD
KS
Enumeration date
08/31/2006
Last updated
01/04/2021
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