Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist |
NPI | 1851044143 |
---|---|
Provider Name | Zhaoyang Fan |
First Address | Palos Verdes Estates, CA 90274-2763 |
Second Address | Los Angeles, CA 90089-5601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2022 |
Last Update Date | 27/01/2022 |