Provider Demographics
NPI:1255210985
Name:FANG, SIDA
Entity type:Individual
Prefix:
First Name:SIDA
Middle Name:
Last Name:FANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:WILL
Other - Middle Name:
Other - Last Name:FANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1779 WOODSIDE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3438
Mailing Address - Country:US
Mailing Address - Phone:650-424-0854
Mailing Address - Fax:
Practice Address - Street 1:1779 WOODSIDE RD STE 200
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3438
Practice Address - Country:US
Practice Address - Phone:650-424-0854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)