Kenneth Fan, DO

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

294548 Issued in NY

Practice address

219 Bryant St
University at Buffalo Department of OB/GYN
Buffalo, NY 14222

Phone

(716) 878-7750

Fax

(716) 888-3833

NPI assigned

Apr 30, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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 1

Specialty

Obstetrics/Gynecology

Education

Arizona College of Osteopathic Medicine Mid Western University, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Allsafe Medical Group IncGroup PAC ID 8527245612, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: kfan682472@direct.memorialcare.org

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.

• Allsafe Medical Group Inc.

  • Obstetrics & Gynecology Physician
  • Downey, CA
  • NPI 1457596371
  Medicare reassignment Care Compare group NPD
• St Francis Medical Center, Inc

  • General Acute Care Hospital
  • Monroe, LA
  • NPI 1295723229
  NPD (past)
• University of California Irvine

  dba UCI Health - Fountain Valley

  • General Acute Care Hospital
  • Fountain Valley, CA
  • NPI 1821002007
  NPD (past)

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

{
    "created_epoch": "1398816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530144000000",
    "number": "1801206750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 ADMIRALS WALK",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142024333",
            "telephone_number": "626-841-8082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 BRYANT ST",
            "address_2": "UNIVERSITY AT BUFFALO DEPARTMENT OF OB/GYN",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "14222",
            "telephone_number": "716-878-7750",
            "fax_number": "716-888-3833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAN",
        "first_name": "KENNETH",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-30",
        "last_updated": "2018-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "294548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Families' Child Advocacy Network, Inc.
• Families' Child Advocacy Network,Inc.
• Family Dental Associates (Family Dental Center)
• Family Pharmaceutical Services LLC (High Street Prescription Center)
• Family Pharmaceutical Services LLC (High Street Prescription Center)
• Liang Fan, MD
• Kyle Fancher, DC
• Xiaohong Fang, MD
• Maraiel J Faraco, LCSW
• Omar Awil Farah, RN, BSN

• Obstetrics & Gynecology Physician in Buffalo, NY
• Providers in Buffalo, NY by specialty
• Obstetrics & Gynecology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.