Provider Demographics
NPI:1649821885
Name:FAN, TING WEN (PHD, OMD, LAC)
Entity type:Individual
Prefix:DR
First Name:TING WEN
Middle Name:
Last Name:FAN
Suffix:
Gender:F
Credentials:PHD, OMD, LAC
Other - Prefix:DR
Other - First Name:TING-WEN
Other - Middle Name:
Other - Last Name:HESSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, OMD, LAC
Mailing Address - Street 1:3369 AVOCADO HILL WAY
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6253
Mailing Address - Country:US
Mailing Address - Phone:310-359-3911
Mailing Address - Fax:
Practice Address - Street 1:223 N GARFIELD AVE STE 301
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1700
Practice Address - Country:US
Practice Address - Phone:310-359-3911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9793171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty