Healthcare Provider Details

I. General information

NPI: 1619596152
Provider Name (Legal Business Name): DAVID FAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 LENNON LN BLDG 3
WALNUT CREEK CA
94598-2419
US

IV. Provider business mailing address

3050 DEL HOMBRE LN APT 549
WALNUT CREEK CA
94597-2366
US

V. Phone/Fax

Practice location:
  • Phone: 925-906-2015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA176237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: