Provider Demographics
NPI:1326537044
Name:FAN, JUSTON (DO)
Entity type:Individual
Prefix:DR
First Name:JUSTON
Middle Name:
Last Name:FAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40949 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6031
Mailing Address - Country:US
Mailing Address - Phone:505-259-5822
Mailing Address - Fax:951-296-6675
Practice Address - Street 1:40949 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6031
Practice Address - Country:US
Practice Address - Phone:951-296-6676
Practice Address - Fax:951-296-6675
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A19612207XS0106X
TX764034207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery