Provider Demographics
NPI:1154338580
Name:FANG, MICHAEL SHAOYI (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SHAOYI
Last Name:FANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SHAOYI
Other - Middle Name:
Other - Last Name:FANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3129 S HACIENDA BLVD
Mailing Address - Street 2:STE 159
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6304
Mailing Address - Country:US
Mailing Address - Phone:626-262-3317
Mailing Address - Fax:
Practice Address - Street 1:11480 BROOKSHIRE AVE
Practice Address - Street 2:STE 302
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5024
Practice Address - Country:US
Practice Address - Phone:626-337-2265
Practice Address - Fax:626-337-6625
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222907207RN0300X
CAA88548207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A885480Medicaid
CAH51914Medicare UPIN
CA00A885480Medicaid