Provider Demographics
NPI:1508881715
Name:FAN, JOSEPH T (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:T
Last Name:FAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:11370 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3450
Mailing Address - Country:US
Mailing Address - Phone:909-558-2154
Mailing Address - Fax:909-558-2180
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2020-07-29
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Provider Licenses
StateLicense IDTaxonomies
CAG82302207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G823020Medicaid
F45051Medicare UPIN
CA00G823020Medicaid