Provider Demographics
NPI:1235291733
Name:FANG, KEH NAN
Entity Type:Individual
Prefix:
First Name:KEH
Middle Name:NAN
Last Name:FANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3974 OKEECHOBEE BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-4043
Mailing Address - Country:US
Mailing Address - Phone:561-640-3986
Mailing Address - Fax:
Practice Address - Street 1:3974 OKEECHOBEE BLVD STE 5
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-4043
Practice Address - Country:US
Practice Address - Phone:561-640-3986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1712171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist