Active NPI
David Fann
- Family Medicine Physician
- Garden Grove, CA
National Provider Identifier
1982098182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 20A14926
- Practice address
- 12751 Harbor Blvd
Garden Grove, CA 92840 - Phone
- (888) 499-9303
- NPI assigned
- Mar 25, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 20A14926 | CA | Primary |
Addresses
Primary practice location
12751 Harbor Blvd
Garden Grove, CA 92840
Mailing address
12751 Harbor Blvd
Garden Grove, CA 92840-5800
Phone (888) 499-9303
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170811002479 | CA | Order and Referring Only - Family Practice | 8022389857 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14926 | CA | MD | Optometrist |
| 20A14926 | CA | MD | Family Medicine Physician |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530748800000",
"number": "1982098182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12751 HARBOR BLVD",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928405800",
"telephone_number": "888-499-9303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12751 HARBOR BLVD",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "92840",
"telephone_number": "888-499-9303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANN",
"first_name": "DAVID",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-03-25",
"last_updated": "2018-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "20A14926",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garden Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.