Provider Demographics
NPI:1518475862
Name:FAN, KATE (DPT)
Entity Type:Individual
Prefix:DR
First Name:KATE
Middle Name:
Last Name:FAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4870 BARRANCA PKWY STE 340
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 JOURNEY STE 101
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3372
Practice Address - Country:US
Practice Address - Phone:949-349-9555
Practice Address - Fax:949-349-9554
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist