Kevin Y Fan, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

103408 Issued in CA

Practice address

2176 S Atlantic Blvd
Monterey Park, CA 91754

Phone

(323) 888-0681

NPI assigned

Jan 13, 2009

Last updated

Jul 26, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• K. Fan D.D.S., Inc.

  • Dental Clinic/Center
  • Monterey Park, CA
  • NPI 1518424746
  NPD (past) Authorized official
• Goretti Li DDS Inc.

  dba Atlantic Square Dental

  • General Practice Dentistry
  • Monterey Park, CA
  • NPI 1891889291
  NPD (past)

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

{
    "created_epoch": "1231804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564099200000",
    "number": "1629215660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2176 S ATLANTIC BLVD",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917546839",
            "telephone_number": "323-888-0681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2176 S ATLANTIC BLVD",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "91754",
            "telephone_number": "323-888-0681"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "491 W Longden Ave",
            "address_purpose": "LOCATION",
            "city": "Arcadia",
            "state": "CA",
            "postal_code": "910078132",
            "country_code": "US",
            "telephone_number": "626-617-2255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAN",
        "first_name": "KEVIN",
        "middle_name": "Y",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-13",
        "last_updated": "2019-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "57921",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.028934",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "103408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eye Institute of Los Angeles
• Diana Ramirez Fajardo, LCSW, BCBA
• CHI Fan, LMFT
• Emily Nancy Fan, NP
• Joseph T Fan, M.D.
• Ting Wen Fan, PHD, OMD, LAC
• Helen Yi Han Fang
• Peir-Yu Fang, D.O.
• Xu Shandra Fang, L.AC
• Yueli Fang

• General Practice Dentistry in Monterey Park, CA
• Providers in Monterey Park, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2019; 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.