Healthcare Provider Details

I. General information

NPI: 1073597860
Provider Name (Legal Business Name): ALEXANDER HAO FAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31872 COAST HWY
LAGUNA BEACH CA
92651-6773
US

IV. Provider business mailing address

24310 MOULTON PKWY SUITE O #563
LAGUNA HILLS CA
92637-3306
US

V. Phone/Fax

Practice location:
  • Phone: 949-499-1311
  • Fax: 949-499-8695
Mailing address:
  • Phone: 949-680-4500
  • Fax: 949-598-9529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA77706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: