'Young C Fan MD'

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD033897L Issued in PA

Legal business name

'YOUNG C FAN MD'

Practice address

119 E Mechanic St
Titusville, PA 16354-2161

Phone

(814) 827-4602

Fax

(814) 827-6322

NPI assigned

Feb 6, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Young C Fan, M.D.NPI 1447471487

Title

President

Phone

(814) 827-4602

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Young C. Fan, M.D.

  • Specialist
  • Titusville, PA
  • NPI 1447471487
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073585741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 E MECHANIC ST",
            "city": "TITUSVILLE",
            "state": "PA",
            "postal_code": "163542161",
            "telephone_number": "814-827-4602",
            "fax_number": "814-827-6322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 E MECHANIC ST",
            "city": "TITUSVILLE",
            "state": "PA",
            "postal_code": "163542161",
            "telephone_number": "814-827-4602",
            "fax_number": "814-827-6322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "'YOUNG C FAN MD'",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FAN",
        "authorized_official_first_name": "YOUNG",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "814-827-4602",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD033897L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006010740001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PENNSYLVANIA BLUE SHIELD",
            "identifier": "032140",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Richard Carl Bienio

• Specialist in Titusville, PA
• Providers in Titusville, PA by specialty
• Specialist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.