Provider Demographics
NPI:1780032839
Name:FAN, KENNETH CHEN (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CHEN
Last Name:FAN
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4460 BISSONNET ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3218
Mailing Address - Country:US
Mailing Address - Phone:713-524-3434
Mailing Address - Fax:713-524-3220
Practice Address - Street 1:4460 BISSONNET ST STE 200
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3218
Practice Address - Country:US
Practice Address - Phone:713-524-3434
Practice Address - Fax:713-524-3220
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME145099207W00000X, 207WX0107X
TXT7917207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist