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General NPI Number Information
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NPI Number | 1477883486
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Entity Type | Individual
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Provider Name | EMMANUEL K. FAI PA-C, PHD
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Gender | Male
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Dates
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Enumeration Date | 01/14/2010
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 8118 GOOD LUCK RD
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City | LANHAM
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State | MD
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Zip | 20706-3574
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Country | US
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Telephone | 301-552-8130
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Fax |
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Provider Business Mailing Address
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Address Line | 800 BRADBURY DR SE STE 116
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4310
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Country | US
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Telephone | 505-272-1476
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0004092
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | CO4092
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2024-0084
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License Number State | NM
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