MEDICARE: DR. KATE FAN DPT

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
1	225100000X	Physical Therapist	294004	CA

General Provider Information

NPI Number	:	1518475862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATE FAN DPT

Provider Business Mailing Address
First Line	:	2 JOURNEY STE 101
Second Line	:
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-3372
Country	:	US
Telephone Number	:	949-349-9555
Fax Number	:	949-349-9554

Provider Business Practice Location Address
First Line	:	2 JOURNEY STE 101
Second Line	:
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-3372
Country	:	US
Telephone Number	:	949-349-9555
Fax Number	:	949-349-9554

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2018
Last Update Date	:	01/05/2026

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