Provider Demographics
NPI:1902884000
Name:FAN, WILLIAM LI-GOON (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LI-GOON
Last Name:FAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3031 NEW BERN AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-2989
Mailing Address - Country:US
Mailing Address - Phone:919-231-3966
Mailing Address - Fax:919-231-3912
Practice Address - Street 1:3604 BUSH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7511
Practice Address - Country:US
Practice Address - Phone:919-876-7807
Practice Address - Fax:919-876-8823
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2022-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC200200682207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900545Medicaid
NC1384MOtherBCBS PROVIDER NUMBER
NC5900545Medicaid
NC1384MOtherBCBS PROVIDER NUMBER