Healthcare Provider Details

I. General information

NPI: 1437084076
Provider Name (Legal Business Name): YUANXIN FAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N INGALLS ST
ANN ARBOR MI
48109-2003
US

IV. Provider business mailing address

3819 ROYAL BERKSHIRE LN
OAKLAND MI
48363-2364
US

V. Phone/Fax

Practice location:
  • Phone: 330-208-5282
  • Fax:
Mailing address:
  • Phone: 330-208-5282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704405807
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: