Venus Fanous, D.D.S.,
Individual provider Active NPI Dentist · Corcoran, CA
NPI 1689861320 · NPPES record last updated Sep 26, 2007
Key facts
- NPI
- 1689861320
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 53319 (CA)
- Practice address
- 900 Quebec Ave.
Corcoran, CA 93212-7100 - Phone
- (559) 992-7100
- NPI assigned
- Sep 26, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 53319 | CA | Yes |
Addresses
Primary practice location
900 Quebec Ave.
Corcoran, CA 93212-7100
Mailing address
11704 Valley Forge Way
Bakersfield, CA 93312-8288
Phone (661) 900-8442
Other providers in Corcoran, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.