Active NPI
Wen S Fan, DMD, MD
- Oral and Maxillofacial Surgery (Dentist)
- San Jose, CA
National Provider Identifier
1164645750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 52603
- Practice address
- 2039 Forest Ave Ste 306
San Jose, CA 95128-4830 - Phone
- (408) 298-7775
- NPI assigned
- Apr 11, 2007
- Last updated
- May 3, 2009
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 52603 | CA | |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 52603 | CA | Primary |
Addresses
Primary practice location
2039 Forest Ave Ste 306
San Jose, CA 95128-4830
Mailing address
1235 Brockton Ave
#206
Los Angeles, CA 90025-1344
Phone (310) 770-5498
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52603 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cheng DDS MD Inc and Wen S Fan DMD MD Inc a Partnership | Oral and Maxillofacial Surgery | Past | Accepting new patients |
| Wen S. Fan DMD, MD and Cheng DDS, MD | Oral and Maxillofacial Surgery | Past | Accepting new patients |
Interoperability endpoints
- wfan125657@santaclaravalley.direct-ci.net
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Cupertino Oral Surgery & Dental Implants
- Oral and Maxillofacial Surgery (Dentist)
- Cupertino, CA
- NPI 1699044065
-
dba Maxillofacial Surgery Center of San Jose
- Oral and Maxillofacial Surgery (Dentist)
- San Jose, CA
- NPI 1174530026
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241308800000",
"number": "1164645750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1235 BROCKTON AVE",
"address_2": "#206",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900251344",
"telephone_number": "310-770-5498"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2039 FOREST AVE STE 306",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951284830",
"telephone_number": "408-298-7775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAN",
"first_name": "WEN",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "DMD, MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-11",
"last_updated": "2009-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "52603",
"primary": false
},
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "CA",
"license": "52603",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.