Provider Demographics
NPI:1750313268
Name:FANN, JAMES I-LIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:I-LIN
Last Name:FANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3801 MIRANDA AVENUE
Mailing Address - Street 2:VA PALO ALTO HCS
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304
Mailing Address - Country:US
Mailing Address - Phone:650-858-3917
Mailing Address - Fax:650-852-3430
Practice Address - Street 1:3801 MIRANDA AVE
Practice Address - Street 2:VA PALO ALTO HCS
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-858-3917
Practice Address - Fax:650-852-3430
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57873208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG42394Medicare UPIN