Provider Demographics
NPI:1992803050
Name:FAN, HE-PING (LAC)
Entity type:Individual
Prefix:
First Name:HE-PING
Middle Name:
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 1:1300 E MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4149
Mailing Address - Country:US
Mailing Address - Phone:626-281-2892
Mailing Address - Fax:626-281-2892
Practice Address - Street 1:1300 E MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4149
Practice Address - Country:US
Practice Address - Phone:626-281-2892
Practice Address - Fax:626-281-2892
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4623171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC4623OtherSTATE LICENSE