Healthcare Provider Details

I. General information

NPI: 1174772818
Provider Name (Legal Business Name): CHIXIN FANG MEDICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 58TH ST # 1A
BROOKLYN NY
11220-3917
US

IV. Provider business mailing address

730 58TH STREET 1A
BROOKLYN NY
11220-3917
US

V. Phone/Fax

Practice location:
  • Phone: 718-439-7288
  • Fax: 718-439-0788
Mailing address:
  • Phone: 718-439-7288
  • Fax: 718-439-0788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number234095
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number249103-1
License Number StateNY

VIII. Authorized Official

Name: MRS. CHIXIN FANG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-439-7288