Fang Tan MD, Inc.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

A81026 Issued in CA

Legal business name

FANG TAN MD, INC.

Practice address

1895 Mowry Ave
Suite 101a
Fremont, CA 94538-1708

Phone

(510) 793-2800

Fax

(510) 793-2882

NPI assigned

Apr 14, 2006

Last updated

Aug 19, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Fang Tan, M.D.NPI 1811997646

Title

Ceo

Phone

(510) 793-2800

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Fang Tan, MD

  • Ophthalmology Physician
  • Fremont, CA
  • NPI 1811997646
  Medicare reassignment NPD Authorized official
• Ana M. Elisei, MD

  • Internal Medicine Physician
  • Fremont, CA
  • NPI 1508054479
  NPD (past)

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439942400000",
    "number": "1710941091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3232 BRUCE DR",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945395013",
            "telephone_number": "510-793-2800",
            "fax_number": "510-793-2882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1895 MOWRY AVE",
            "address_2": "SUITE 101A",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381708",
            "telephone_number": "510-793-2800",
            "fax_number": "510-793-2882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FANG TAN MD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-14",
        "last_updated": "2015-08-19",
        "status": "A",
        "authorized_official_last_name": "TAN",
        "authorized_official_first_name": "FANG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "510-793-2800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "A81026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A810260",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Crystal L Fan
• Justine Fan
• Shurun Fan
• Stephen T. Fan, D.M.D.
• Yanhua Fan
• Chih Yang Fang
• Chih-Yu Fang
• Melanie Fang, M.A., LMFT
• Ryan Eliot Fanno, AMFT
• Steven Michael Fanucchi, M.F.T.

• Ophthalmology Physician in Fremont, CA
• Providers in Fremont, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.