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General NPI Number Information
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NPI Number | 1629215660
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Entity Type | Individual
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Provider Name | KEVIN Y FAN DDS
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Gender | Male
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Dates
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Enumeration Date | 01/13/2009
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Last Update Date | 07/26/2019
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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
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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 | 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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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 57921
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.028934
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 103408
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License Number State | CA
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