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General NPI Number Information
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NPI Number | 1346008109
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Entity Type | Individual
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Provider Name | AUSTIN FAN MD
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Gender | Male
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Dates
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Enumeration Date | 03/07/2024
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 420 E SUPERIOR ST STE 9-900
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City | CHICAGO
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State | IL
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Zip | 60611-4494
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Country | US
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Telephone | 312-503-7975
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Fax |
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Provider Business Mailing Address
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Address Line | 9500 GILMAN DR
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City | LA JOLLA
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State | CA
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Zip | 92093-0004
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 125.086631
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License Number State | IL
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