Provider Demographics
NPI:1285760959
Name:FAN, MAY JIAN NIAN (LAC)
Entity type:Individual
Prefix:MRS
First Name:MAY
Middle Name:JIAN NIAN
Last Name:FAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 KINAU ST
Mailing Address - Street 2:#303
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2527
Mailing Address - Country:US
Mailing Address - Phone:808-533-2820
Mailing Address - Fax:808-533-2820
Practice Address - Street 1:100 N BERETANIA ST
Practice Address - Street 2:#158
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4712
Practice Address - Country:US
Practice Address - Phone:808-533-2820
Practice Address - Fax:808-533-2820
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI617171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1039139OtherAMERICAN SPECIALTY HEALTH