Healthcare Provider Details

I. General information

NPI: 1598850646
Provider Name (Legal Business Name): HENRY Y FANG M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HORNG Y FANG M.D

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/31/2021
Certification Date: 12/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 WEATHERSTONE LN
ELGIN IL
60123-2059
US

IV. Provider business mailing address

1590 WEATHERSTONE LN
ELGIN IL
60123-2059
US

V. Phone/Fax

Practice location:
  • Phone: 847-695-7992
  • Fax: 847-695-5789
Mailing address:
  • Phone: 847-695-7992
  • Fax: 847-695-5789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36-51626
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: