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General NPI Number Information
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NPI Number | 1073585741
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Entity Type | Organization
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Legal Business Name | 'YOUNG C FAN MD'
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 119 E MECHANIC ST
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City | TITUSVILLE
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State | PA
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Zip | 16354-2161
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Country | US
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Telephone | 814-827-4602
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Fax | 814-827-6322
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Provider Business Mailing Address
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Address Line | 119 E MECHANIC ST
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City | TITUSVILLE
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State | PA
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Zip | 16354-2161
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Country | US
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Telephone | 814-827-4602
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Fax | 814-827-6322
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YOUNG C FAN
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Credential | M.D.
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Telephone | 814-827-4602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD033897L
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License Number State | PA
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