Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 34092 | CA |
NPI | 1053454231 |
---|---|
Provider Name | Dr. Victor S. C. Fan |
First Address | Long Beach, CA 90807-3502 |
Second Address | Long Beach, CA 90807-3502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/07/2007 |