Provider Demographics
NPI:1184622433
Name:FANG, LEEHSIN BILLY (DPM)
Entity type:Individual
Prefix:DR
First Name:LEEHSIN
Middle Name:BILLY
Last Name:FANG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:226 ECHO AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-4727
Mailing Address - Country:US
Mailing Address - Phone:408-903-3414
Mailing Address - Fax:650-963-9813
Practice Address - Street 1:2500 HOSPITAL DRIVE, BLDG15
Practice Address - Street 2:SUITE 4
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4106
Practice Address - Country:US
Practice Address - Phone:650-386-1328
Practice Address - Fax:650-963-9813
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2020-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAE5118213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE5118OtherCALIFORNIA PODIATRIST LICENSE
CA7483160001OtherDME NSC PTAN
CA1184622433OtherNPI
HI56436Medicare PIN
HI56434Medicare UPIN
HI556110Medicaid