Jingyuan Fan, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

000054 Issued in NY

Practice address

3450 Lacey Road
Downers Grove, IL 60515-2668

Phone

(630) 743-4967

Fax

(630) 743-4537

NPI assigned

Jul 15, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2016 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: jfan18632@direct.midwestern.edu

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

{
    "created_epoch": "1405382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471651200000",
    "number": "1952718629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 LACEY ROAD",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605152668",
            "telephone_number": "630-743-4967",
            "fax_number": "630-743-4537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 LACEY ROAD",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605152668",
            "telephone_number": "630-743-4967",
            "fax_number": "630-743-4537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAN",
        "first_name": "JINGYUAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-15",
        "last_updated": "2016-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NY",
            "license": "000054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Anthony Falco, DO
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• Family Health and Wellness Clinic S C
• Family Health and Wellness Solutions LLC
• Farhad Vossoughi MD SC
• Farhana Supplies Inc
• Carlos Luis Farias, M.D.
• Charles A Faron, OD
• Sulaiman Farooqui, DO

• Periodontics in Downers Grove, IL
• Providers in Downers Grove, IL by specialty
• Periodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2016; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.