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General NPI Number Information
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NPI Number | 1699044065
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Entity Type | Organization
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Legal Business Name | WEN S. FAN DMD, MD AND CHENG DDS, MD
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Dates
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Enumeration Date | 12/14/2011
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Last Update Date | 12/14/2011
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Provider Practice Location Address
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Address Line | 20530 TOWN CENTER LN
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City | CUPERTINO
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State | CA
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Zip | 95014-3200
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Country | US
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Telephone | 408-517-0985
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Fax | 408-517-8861
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Provider Business Mailing Address
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Address Line | 20530 TOWN CENTER LN
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City | CUPERTINO
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State | CA
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Zip | 95014-3200
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Country | US
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Telephone | 408-517-0985
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Fax | 408-517-8861
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WEN FAN
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Credential | DMD, MD
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Telephone | 408-517-0985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State | CA
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