Individual
AUSTIN FAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
420 E SUPERIOR ST STE 9-900, CHICAGO, IL 60611-4494
(312) 503-7975
Mailing address
9500 GILMAN DR, LA JOLLA, CA 92093-0004
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
125.086631
IL
Other
Enumeration date
03/07/2024
Last updated
06/19/2025
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