Provider Demographics
NPI:1487702882
Name:FANG, JANE (MD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:FANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 MONTGOMERY ST
Mailing Address - Street 2:SUITE #200
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-1030
Mailing Address - Country:US
Mailing Address - Phone:415-666-1250
Mailing Address - Fax:415-398-2696
Practice Address - Street 1:1725 MONTGOMERY ST
Practice Address - Street 2:SUITE #200
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-1030
Practice Address - Country:US
Practice Address - Phone:415-666-1250
Practice Address - Fax:415-398-2696
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85655174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF52073Medicare UPIN