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General NPI Number Information
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NPI Number | 1669648408
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Entity Type | Individual
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Provider Name | RONG FAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 7455 W WASHINGTON AVE STE 301
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City | LAS VEGAS
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State | NV
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Zip | 89128-4340
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Country | US
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Telephone | 702-732-3441
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Fax |
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Provider Business Mailing Address
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Address Line | 1355 RIVER BEND DR
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City | DALLAS
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State | TX
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Zip | 75247-4915
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Country | US
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Telephone | 27-732-3441
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 01065131A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 4301510501
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207ZP0213X
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Taxonomy Name | Pediatric Pathology Physician
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License Number | 313196-01
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 27457
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License Number State | NV
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