Provider Demographics
NPI:1790911568
Name:FAN, VIVIAN HANBING (DMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:HANBING
Last Name:FAN
Suffix:
Gender:F
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 SWANSBURY DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-4628
Mailing Address - Country:US
Mailing Address - Phone:804-737-8777
Mailing Address - Fax:804-658-1158
Practice Address - Street 1:45 W WILLIAMSBURG RD
Practice Address - Street 2:
Practice Address - City:SANDSTON
Practice Address - State:VA
Practice Address - Zip Code:23150-2040
Practice Address - Country:US
Practice Address - Phone:804-737-8777
Practice Address - Fax:804-737-8799
Is Sole Proprietor?:No
Enumeration Date:2009-06-06
Last Update Date:2009-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014116211223X0400X
MA201631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics