Individual provider · Type 1 NPI
Wen S. Fan, DMD, MD
Oral and Maxillofacial Surgery (Dentist) · San Jose, CA
Practice location
2039 Forest Ave Ste 306
San Jose, CA 95128-4830
Mailing address
1235 Brockton Ave, #206
Los Angeles, CA 90025-1344
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist | 122300000X | 52603 (CA) |
| Oral and Maxillofacial Surgery (Dentist) Primary | 1223S0112X | 52603 (CA) |
Oral and Maxillofacial Surgery (Dentist): The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
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About NPI 1164645750
Wen S. Fan, DMD, MD's National Provider Identifier is 1164645750, issued on Apr 11, 2007. The primary taxonomy on file is Oral and Maxillofacial Surgery (Dentist) (1223S0112X), and the practice location is in San Jose, CA. The record was last updated on May 3, 2009.