Active NPI
Ko Bruce Fang, PH.D.
- Clinical Psychologist
- Fresno, CA
National Provider Identifier
1376664458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY18841
- Practice address
- 2822 N. Blackstone Avenue
Fresno, CA 93703 - Phone
- (559) 229-0227
- Fax
- (559) 229-0227
- NPI assigned
- Apr 3, 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY18841 | CA | Primary |
Addresses
Primary practice location
2822 N. Blackstone Avenue
Fresno, CA 93703
Mailing address
9895 Selva Way
Elk Grove, CA 95757
Phone (916) 296-5089
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY18841 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376664458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9895 SELVA WAY",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "95757",
"telephone_number": "916-296-5089",
"fax_number": "559-229-0227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2822 N. BLACKSTONE AVENUE",
"city": "FRESNO",
"state": "CA",
"postal_code": "93703",
"telephone_number": "559-229-0227",
"fax_number": "559-229-0227"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANG",
"first_name": "KO",
"middle_name": "BRUCE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY18841",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, 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.