Healthcare Provider Details

I. General information

NPI: 1386387470
Provider Name (Legal Business Name): JAMES FAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST FL 3
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

622 W 168TH ST FL 3
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-9535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number343119-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: