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NPI Code Detail

MEDICARE: DR. KAILI FAN MD

MEDICARE: DR. KAILI FAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RI0200XInfectious Disease Physician112063MO
2207RI0200XInfectious Disease Physician35086851OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396737094
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KAILI FAN MD
Provider Business Mailing Address
First Line : 33 W RAHN RD
Second Line :
City : DAYTON
State : OH
Zip : 45429-2219
Country : US
Telephone Number : 937-433-8990
Fax Number : 937-433-8691
Provider Business Practice Location Address
First Line : 33 W RAHN RD
Second Line :
City : DAYTON
State : OH
Zip : 45429-2219
Country : US
Telephone Number : 937-433-8990
Fax Number : 937-433-8691
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2005
Last Update Date : 09/04/2007

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Directions to “ DR. KAILI FAN MD” Practice Location

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