Provider Demographics
NPI:1679783310
Name:FAN, ROBIN (LAC)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:FAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1260 IROQUOIS AVE
Mailing Address - Street 2:STE 308
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1689
Mailing Address - Country:US
Mailing Address - Phone:630-355-0300
Mailing Address - Fax:630-355-0304
Practice Address - Street 1:1260 IROQUOIS AVE
Practice Address - Street 2:STE 308
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563
Practice Address - Country:US
Practice Address - Phone:630-355-0300
Practice Address - Fax:630-355-0304
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist