Active NPI
Gainson Fan, DRPH, DPM, DNM, PHD
- Community Health Worker
- Miami Shores, FL
National Provider Identifier
1104773555
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 9620 NE 2ND Ave Ste 203
Miami Shores, FL 33138-2749 - Phone
- (954) 399-2296
- NPI assigned
- Mar 13, 2026
- 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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
9620 NE 2ND Ave Ste 203
Miami Shores, FL 33138-2749
Mailing address
9620 NE 2ND Ave Ste 203
Miami Shores, FL 33138-2749
Phone (954) 399-2296
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
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1773360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773360000000",
"number": "1104773555",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9620 NE 2ND AVE STE 203",
"city": "MIAMI SHORES",
"state": "FL",
"postal_code": "331382749",
"telephone_number": "954-399-2296"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9620 NE 2ND AVE STE 203",
"city": "MIAMI SHORES",
"state": "FL",
"postal_code": "331382749",
"telephone_number": "954-399-2296"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAN",
"first_name": "GAINSON",
"name_prefix": "Dr.",
"credential": "DRPH, DPM, DNM, PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-03-13",
"last_updated": "2026-03-13",
"certification_date": "2026-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Miami Shores, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.