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NPI Code Detail

MEDICARE: DR. ALEXANDER HAO FAN M.D.

MEDICARE: DR. ALEXANDER HAO FAN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianA77706CA

General Provider Information

NPI Number : 1073597860
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALEXANDER HAO FAN M.D.
Provider Business Mailing Address
First Line : 24310 MOULTON PKWY
Second Line : SUITE O #563
City : LAGUNA HILLS
State : CA
Zip : 92637-3306
Country : US
Telephone Number : 949-680-4500
Fax Number : 949-598-9529
Provider Business Practice Location Address
First Line : 31872 COAST HWY
Second Line :
City : LAGUNA BEACH
State : CA
Zip : 92651-6773
Country : US
Telephone Number : 949-499-1311
Fax Number : 949-499-8695
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2005
Last Update Date : 06/13/2016

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