Basic Information
Provider Information
NPI: 1417243890
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHAN
FirstName: ZAR
MiddleName: C
NamePrefix: DR.
NameSuffix:  
Credential: M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1000W CARSON ST
Address2:  
City: TORRANCE
State: CA
PostalCode: 905022004
CountryCode: US
TelephoneNumber: 3102223891
FaxNumber:  
Practice Location
Address1: 1000 W CARSON ST BLDG N-28
Address2:  
City: TORRANCE
State: CA
PostalCode: 905022004
CountryCode: US
TelephoneNumber: 3102223891
FaxNumber: 3107821837
Other Information
ProviderEnumerationDate: 06/23/2011
LastUpdateDate: 07/19/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RN0300XA129247CAY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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