Healthcare Provider Details

I. General information

NPI: 1184622433
Provider Name (Legal Business Name): LEEHSIN BILLY FANG D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL DRIVE, BLDG15 SUITE 4
MOUNTAIN VIEW CA
94040-4106
US

IV. Provider business mailing address

226 ECHO AVE SUITE 3
CAMPBELL CA
95008-4727
US

V. Phone/Fax

Practice location:
  • Phone: 650-386-1328
  • Fax: 650-963-9813
Mailing address:
  • Phone: 408-903-3414
  • Fax: 650-963-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: