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NPI Code Detail

MEDICARE: JOHNNY FANG

MEDICARE: JOHNNY FANG
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
1106H00000XMarriage & Family TherapistCA

General Provider Information

NPI Number : 1881176790
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHNNY FANG
Provider Business Mailing Address
First Line : 3010 COLBY ST STE 221
Second Line :
City : BERKELEY
State : CA
Zip : 94705-2056
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3010 COLBY ST STE 221
Second Line :
City : BERKELEY
State : CA
Zip : 94705-2056
Country : US
Telephone Number : 510-922-9757
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2018
Last Update Date : 08/05/2022

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Directions to “ JOHNNY FANG ” Practice Location

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