Healthcare Provider Details

I. General information

NPI: 1073585741
Provider Name (Legal Business Name): 'YOUNG C FAN MD'
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 E MECHANIC ST
TITUSVILLE PA
16354-2161
US

IV. Provider business mailing address

119 E MECHANIC ST
TITUSVILLE PA
16354-2161
US

V. Phone/Fax

Practice location:
  • Phone: 814-827-4602
  • Fax: 814-827-6322
Mailing address:
  • Phone: 814-827-4602
  • Fax: 814-827-6322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD033897L
License Number StatePA

VIII. Authorized Official

Name: DR. YOUNG C FAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 814-827-4602