Provider Demographics
NPI:1083886741
Name:FAN, AMELIA MURTI (MD)
Entity Type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:MURTI
Last Name:FAN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:801 S CHEVY CHASE DR
Mailing Address - Street 2:#20
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4431
Mailing Address - Country:US
Mailing Address - Phone:323-344-4144
Mailing Address - Fax:323-344-4146
Practice Address - Street 1:5059 YORK BLVD
Practice Address - Street 2:MS#68
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-1713
Practice Address - Country:US
Practice Address - Phone:323-344-4144
Practice Address - Fax:323-344-4146
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2010-06-17
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Provider Licenses
StateLicense IDTaxonomies
CAA103199208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics