Provider Demographics
NPI:1366889784
Name:JANE CHI FAN, MFT. INC
Entity type:Organization
Organization Name:JANE CHI FAN, MFT. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHI
Authorized Official - Middle Name:
Authorized Official - Last Name:FAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA; LMFT
Authorized Official - Phone:626-388-7682
Mailing Address - Street 1:941 S. ATLANTIC BLVD.,
Mailing Address - Street 2:SUITE 221
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754
Mailing Address - Country:US
Mailing Address - Phone:626-284-4202
Mailing Address - Fax:626-284-3926
Practice Address - Street 1:941 S. ATLANTIC BLVD.,
Practice Address - Street 2:SUITE 221
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754
Practice Address - Country:US
Practice Address - Phone:626-284-4202
Practice Address - Fax:626-284-3926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35165106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty