Individual
KENNETH FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
219 BRYANT ST, UNIVERSITY AT BUFFALO DEPARTMENT OF OB/GYN, BUFFALO, NY 14222
(716) 878-7750
(716) 888-3833
Mailing address
405 ADMIRALS WALK, BUFFALO, NY 14202-4333
(626) 841-8082
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
294548
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/30/2014
Last updated
06/28/2018
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