Provider Demographics
NPI:1467825638
Name:FAN, ZHE
Entity Type:Individual
Prefix:
First Name:ZHE
Middle Name:
Last Name:FAN
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 1:8611 WHITNEY AVE APT 5D
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3632
Mailing Address - Country:US
Mailing Address - Phone:718-412-0089
Mailing Address - Fax:
Practice Address - Street 1:8611 WHITNEY AVE APT 5D
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3632
Practice Address - Country:US
Practice Address - Phone:718-412-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization