Vincent C Fan, MD, MBA, MA, FAAO

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

A121231 Issued in CA

Practice address

5755 Cottle Rd BLDG 22
San Jose, CA 95123-3600

Phone

(408) 972-6570

NPI assigned

Dec 2, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, HI, NY3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Master of Business Administration, Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kern County Hospital Authority

  • General Acute Care Hospital
  • Bakersfield, CA
  • NPI 1376623538

  CA

  Medicare reassignment NPD
• Riverside Medical Clinic, Inc

  • Dermatology Physician
  • Riverside, CA
  • NPI 1720183403

  CA

  Medicare reassignment NPD
• Hawaii Permanente Medical Group Inc

  • Health Maintenance Organization
  • Honolulu, HI
  • NPI 1710945969

  HI

  Medicare reassignment NPD
• Rochester General Hospital

  • Family Medicine Physician
  • Rochester, NY
  • NPI 1356412712

  NY

  Medicare reassignment NPD
• High Desert Limb Salvage Institute Podiatrist Corp

  • Podiatric Clinic/Center
  • Apple Valley, CA
  • NPI 1588132062
  NPD
• Kern County Hospital Authority

  • General Acute Care Hospital
  • Bakersfield, CA
  • NPI 1376960005
  NPD
• Riverside Medical Clinic, Inc

  • Internal Medicine Physician
  • Riverside, CA
  • NPI 1730180415

  Ophthalmology

  NPD
• Riverside Medical Clinic, Inc

  • Internal Medicine Physician
  • Riverside, CA
  • NPI 1982013884
  NPD
• Rochester General Hospital

  • General Acute Care Hospital
  • Rochester, NY
  • NPI 1255360517
  NPD

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

{
    "created_epoch": "1228176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681430400000",
    "number": "1356586549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5775 COTTLE ROAD",
            "address_2": "BUILDING 25",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95123",
            "telephone_number": "408-972-6570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5755 COTTLE RD BLDG 22",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951233600",
            "telephone_number": "408-972-6570"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1721 Westwind Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Bakersfield",
            "state": "CA",
            "postal_code": "933013026",
            "country_code": "US",
            "telephone_number": "661-215-1006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAN",
        "first_name": "VINCENT",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD, MBA, MA, FAAO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-12-02",
        "last_updated": "2023-04-14",
        "certification_date": "2023-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "A121231",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "HI",
            "license": "MD-18421",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036122238",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "242003",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Foroozan Famoori, MD
• Debbi K. Fan, O.D.
• Gavin George Fan, M.D.
• Lisa Fan, O.D.
• Nancy Fan, RD
• Wen Fan, M.A.
• Wen S Fan, DMD, MD
• Yu-Ying Fan, L.AC.
• Thomas Markus Fandel, M.D.
• James Lloyd Fandialan, M.A., LPCC 7084

• All providers in San Jose, CA
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.