Provider Demographics
NPI:1992308563
Name:FAN, YUDAN
Entity type:Individual
Prefix:
First Name:YUDAN
Middle Name:
Last Name:FAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808N.QUINN ST. APT.616
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209
Mailing Address - Country:US
Mailing Address - Phone:703-395-4619
Mailing Address - Fax:
Practice Address - Street 1:1808N.QUINN ST. APT.616
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209
Practice Address - Country:US
Practice Address - Phone:703-395-4619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist