Provider Demographics
NPI:1659086783
Name:FAN, ALEX ING (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:ING
Last Name:FAN
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:224 N FAIR OAKS AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1127 WILSHIRE BLVD STE 800
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3909
Practice Address - Country:US
Practice Address - Phone:213-839-1119
Practice Address - Fax:213-839-1120
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA62342363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant