Provider Demographics
NPI:1508615691
Name:FAN, CHRISTIAN YEONG
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:YEONG
Last Name:FAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 WILLIAM PENN DR
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-4376
Mailing Address - Country:US
Mailing Address - Phone:267-968-1783
Mailing Address - Fax:
Practice Address - Street 1:7946 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3321
Practice Address - Country:US
Practice Address - Phone:215-725-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0446811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice