Wen Ta Fan DDS PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

047296 Issued in NY

Legal business name

WEN TA FAN DDS PC

Practice address

4231 Colden St Ste 204
Flushing, NY 11355-3981

Phone

(718) 539-9130

Fax

(718) 539-9180

NPI assigned

Jul 18, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Wen Ta Fan, DDS

Title

President

Phone

(715) 539-9130

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972521888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4231 COLDEN ST STE 204",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113553981",
            "telephone_number": "718-539-9130",
            "fax_number": "718-539-9180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4231 COLDEN ST STE 204",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113553981",
            "telephone_number": "718-539-9130",
            "fax_number": "718-539-9180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEN TA FAN DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FAN",
        "authorized_official_first_name": "WEN",
        "authorized_official_middle_name": "TA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-539-9130",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NY",
            "license": "047296",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02756412",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mina Adel Salah Welsen, DPM
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• Zhiyuan Wen
• Boqiang Weng, PHARMD
• Chien-Yi Weng, FNP-C

• Dental Clinic/Center in Flushing, NY
• Providers in Flushing, NY by specialty
• Dental Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.