Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 3280 | HI |
N | 208200000X | Surgeon | 3280 | HI |
N | 208600000X | Surgeon | 3280 | HI |
NPI | 1790859718 |
---|---|
Provider Name | Dr. Fong-Liang Fan |
First Address | Honolulu, HI 96813-2496 |
Second Address | Honolulu, HI 96817-1605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 19/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
<D3280 | MDX (01) | |
0000BDSFG | MEDICARE (01) | |
00N0053586 | HMSA (01) | |
04715601 | (05) | HI |
04715601 | ALOHACARE (01) | |
04715601 | MEDICAID (01) | |
193072 | HMA NEW (01) | |
D36114 | (02) | |
D36114 | KAISER PERM (01) |