Healthcare Provider Details

I. General information

NPI: 1700047347
Provider Name (Legal Business Name): HOWARD J FAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 COYLE AVE STE 260
CARMICHAEL CA
95608-0312
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-536-2015
  • Fax: 916-536-2029
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberA116271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: