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General NPI Number Information
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NPI Number | 1518424746
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Entity Type | Organization
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Legal Business Name | K. FAN D.D.S., INC.
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 2176 S ATLANTIC BLVD
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City | MONTEREY PARK
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State | CA
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Zip | 91754-6839
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Country | US
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Telephone | 323-888-0681
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Fax |
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Provider Business Mailing Address
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Address Line | 491 W LONGDEN AVE
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City | ARCADIA
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State | CA
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Zip | 91007-8132
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Country | US
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Telephone | 626-821-1000
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. KEVIN FAN
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Credential | DDS
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Telephone | 626-821-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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