Individual
DR. YOUNG C. FAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
119 EAST MECHANIC STREET, TITUSVILLE, PA 16354-2161
(814) 827-4602
(814) 827-6322
Mailing address
119 EAST MECHANIC STREET, TITUSVILLE, PA 16354-2161
(814) 827-4602
(814) 827-6322
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD033879L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006010740001
—
PA
01
—
032140
PENNSYLVANIA BLUE SHIELD
PA
Enumeration date
05/01/2007
Last updated
07/08/2007
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