Provider Demographics
NPI:1275879496
Name:CHEN, FAN
Entity Type:Individual
Prefix:
First Name:FAN
Middle Name:
Last Name:CHEN
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 1:5460B PEACHTREE IND BLVD
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2235
Mailing Address - Country:US
Mailing Address - Phone:770-455-6673
Mailing Address - Fax:
Practice Address - Street 1:5460B PEACHTREE IND BLVD
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-2235
Practice Address - Country:US
Practice Address - Phone:770-455-6673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-15
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist