Provider Demographics
NPI:1073597860
Name:FAN, ALEXANDER HAO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:HAO
Last Name:FAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:24310 MOULTON PKWY
Mailing Address - Street 2:SUITE O #563
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-3306
Mailing Address - Country:US
Mailing Address - Phone:949-680-4500
Mailing Address - Fax:949-598-9529
Practice Address - Street 1:31872 COAST HWY
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6773
Practice Address - Country:US
Practice Address - Phone:949-499-1311
Practice Address - Fax:949-499-8695
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA777062084P0800X
TXP38822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG99260Medicare UPIN
TX346722YRLZMedicare PIN