Active NPI
Shou-Yuan Fan, L.AC.
- Acupuncturist
- Newark, NJ
National Provider Identifier
1003134206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 25MZ00073400
- Practice address
- 500 Mount Prospect Ave
Newark, NJ 07104-2904 - Phone
- (973) 350-0073
- NPI assigned
- May 12, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 25MZ00073400 | NJ | Primary |
| Acupuncturist | 171100000X | 004232 | NY |
Addresses
Primary practice location
500 Mount Prospect Ave
Newark, NJ 07104-2904
Mailing address
500 Mount Prospect Ave
Newark, NJ 07104-2904
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MZ00073400 | NJ | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332979200000",
"number": "1003134206",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 MOUNT PROSPECT AVE",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071042904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 MOUNT PROSPECT AVE",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071042904",
"telephone_number": "973-350-0073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAN",
"first_name": "SHOU-YUAN",
"credential": "L.AC.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-05-12",
"last_updated": "2012-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "NJ",
"license": "25MZ00073400",
"primary": true
},
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "NY",
"license": "004232",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.