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General NPI Number Information
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NPI Number | 1548833510
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Entity Type | Individual
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Provider Name | WILLIAM FAN FNP-C
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Gender | Male
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 701 E EL CAMINO REAL
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-2833
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Country | US
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Telephone | 650-734-7808
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Fax |
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Provider Business Mailing Address
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Address Line | 325 DISTEL CIR
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City | LOS ALTOS
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State | CA
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Zip | 94022-1408
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95016247
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License Number State | CA
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