Provider Demographics
NPI:1518033265
Name:FAN, ARTHUR Y (LAC PHD OMD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:Y
Last Name:FAN
Suffix:
Gender:M
Credentials:LAC PHD OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7607 LEDFORD STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043
Mailing Address - Country:US
Mailing Address - Phone:703-499-4428
Mailing Address - Fax:703-893-1602
Practice Address - Street 1:8214 OLD COURTHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182
Practice Address - Country:US
Practice Address - Phone:703-499-4428
Practice Address - Fax:703-547-8197
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000278171100000X
DCAC30091171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
J3980001OtherCAREFIRST BCBS