Healthcare Provider Details

I. General information

NPI: 1265746788
Provider Name (Legal Business Name): ERLINDA K. SY FANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 VIA MEDIA
LAFAYETTE CA
94549-2921
US

IV. Provider business mailing address

1115 VIA MEDIA
LAFAYETTE CA
94549-2921
US

V. Phone/Fax

Practice location:
  • Phone: 925-408-5276
  • Fax: 925-283-5969
Mailing address:
  • Phone: 925-408-5276
  • Fax: 925-283-5969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberAFE25909
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: