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NPI Code Detail

MEDICARE: DR. LICHUAN FANG M.D.

MEDICARE: DR. LICHUAN FANG 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
1207Q00000XFamily Medicine PhysicianA55474CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508895004
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LICHUAN FANG M.D.
Provider Business Mailing Address
First Line : 5767 W CENTURY BLVD STE 400
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-5631
Country : US
Telephone Number : 310-301-8771
Fax Number :
Provider Business Practice Location Address
First Line : 6344 TOPANGA CANYON BLVD STE 2040
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-2362
Country : US
Telephone Number : 818-610-0292
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 01/14/2021

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Directions to “ DR. LICHUAN FANG M.D.” Practice Location

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