MEDICARE: XIN FAN

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	101YP2500X	Professional Counselor	PC009809	PA

General Provider Information

NPI Number	:	1932626777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XIN FAN

Provider Business Mailing Address
First Line	:	2109 CHRISTIAN ST APT B
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1209
Country	:	US
Telephone Number	:	215-512-6398
Fax Number	:

Provider Business Practice Location Address
First Line	:	2317 S 23RD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-3329
Country	:	US
Telephone Number	:	267-520-0288
Fax Number	:

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

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	08/23/2017

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Directions to “ XIN FAN ” Practice Location

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