Provider Demographics
NPI:1255662664
Name:FAN, CHIN FU (MD)
Entity Type:Individual
Prefix:
First Name:CHIN
Middle Name:FU
Last Name:FAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3265 CRYSTAL PALM COURT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3169
Mailing Address - Country:US
Mailing Address - Phone:702-221-0388
Mailing Address - Fax:702-221-0388
Practice Address - Street 1:3265 CRYSTAL PALM COURT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3169
Practice Address - Country:US
Practice Address - Phone:702-221-0388
Practice Address - Fax:702-221-0388
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYA110274-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology