Raymond Fan, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DDS104689 Issued in CA

Practice address

12860 10TH St
Chino, CA 91710-4294

Phone

(909) 591-0241

NPI assigned

May 2, 2017

Reactivated

Jul 3, 2018

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

Enrolled in CA

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.

Enrollment records 1

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 and National Provider Directory roles.

• Stromberg and Shetty Dental Corporation

  • General Practice Dentistry
  • Apple Valley, CA
  • NPI 1639350119
  NPD (past)
• Albuquerque Modern Dentistry, LLC

  • General Practice Dentistry
  • Albuquerque, NM
  • NPI 1487953790
  NPD (past)

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

{
    "created_epoch": "1493683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697587200000",
    "number": "1962938522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 S ANDREWS AVE",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162510",
            "telephone_number": "954-459-2094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12860 10TH ST",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917104294",
            "telephone_number": "909-591-0241"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 S Andrews Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Lauderdale",
            "state": "FL",
            "postal_code": "333162510",
            "country_code": "US",
            "telephone_number": "954-355-4400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 S Main St",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761044917",
            "country_code": "US",
            "telephone_number": "817-702-1173",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12218 Apple Valley Rd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Apple Valley",
            "state": "CA",
            "postal_code": "923081704",
            "country_code": "US",
            "telephone_number": "760-300-3678",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2800 Coors Blvd NW Ste A",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871201204",
            "country_code": "US",
            "telephone_number": "505-352-1166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAN",
        "first_name": "RAYMOND",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-02",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "deactivation_date": "2018-06-22",
        "reactivation_date": "2018-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NM",
            "license": "DD5682",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "DDS104689",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Excellent Care Home Health Services, Inc.
• Ana Eykel, MFTI
• Carrie Eleanor Fabella, RPT
• David Fairbanks, PMHNP-BC
• Lea Fajardo
• Farah a Ameeri D O Inc
• Farnaz Farhidpour, DDS
• Babak Farzaneh
• Christine Diane Fee, M.S., CCC-SLP
• Cynthia Felix

• Oral and Maxillofacial Surgery (Dentist) in Chino, CA
• Providers in Chino, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.