Basic Information
| Provider Information | |||||||||
| NPI: | 1073597860 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAN | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | HAO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24310 MOULTON PKWY | ||||||||
| Address2: | SUITE O #563 | ||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926373306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9496804500 | ||||||||
| FaxNumber: | 9495989529 | ||||||||
| Practice Location | |||||||||
| Address1: | 31872 COAST HWY | ||||||||
| Address2: | |||||||||
| City: | LAGUNA BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926516773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494991311 | ||||||||
| FaxNumber: | 9494998695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2005 | ||||||||
| LastUpdateDate: | 06/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | A77706 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.