Provider Demographics
NPI:1467644997
Name:JOSEPH T. FAN, M.D.INC
Entity Type:Organization
Organization Name:JOSEPH T. FAN, M.D.INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:FAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-288-2265
Mailing Address - Street 1:500 N GARFIELD AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1242
Mailing Address - Country:US
Mailing Address - Phone:626-288-2265
Mailing Address - Fax:626-288-3761
Practice Address - Street 1:500 N GARFIELD AVE STE 209
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1242
Practice Address - Country:US
Practice Address - Phone:626-288-2265
Practice Address - Fax:626-288-3761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2009-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F45051OtherBLUE CROSS BLUE SHIELD
CAF45051OtherPHYSICIANS' HEALTHWAY
CAW16650Medicare PIN