Active NPI
Victor S. C. Fan, DMD
- Endodontics
- Long Beach, CA
National Provider Identifier
1053454231
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 34092
- Practice address
- 3958 Atlantic Ave
Long Beach, CA 90807-3502 - Phone
- (562) 424-1153
- Fax
- (562) 424-4445
- NPI assigned
- Feb 15, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 34092 | CA | Primary |
Addresses
Primary practice location
3958 Atlantic Ave
Long Beach, CA 90807-3502
Mailing address
3958 Atlantic Ave
Long Beach, CA 90807-3502
Phone (562) 424-1153
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 |
|---|---|---|---|
| 34092 | CA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053454231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3958 ATLANTIC AVE",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908073502",
"telephone_number": "562-424-1153",
"fax_number": "562-424-4445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3958 ATLANTIC AVE",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908073502",
"telephone_number": "562-424-1153",
"fax_number": "562-424-4445"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAN",
"first_name": "VICTOR",
"middle_name": "S. C.",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "34092",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.