Basic Information
| Provider Information | |||||||||
| NPI: | 1437256864 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAN | ||||||||
| FirstName: | HUNG | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 4001 J ST | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958193626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164534966 | ||||||||
| FaxNumber: | 9167391269 | ||||||||
| Practice Location | |||||||||
| Address1: | 3160 FOLSOM BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958165219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167333333 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/25/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G52718 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | G52718 | CA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 90026118 | 01 | CA | PACIFICARE | OTHER | 4067 | 01 | CA | INTERPLAN | OTHER | 5635361 | 01 | CA | FIRST HEALTH | OTHER | MCMG168300 | 01 | CA | WESTERN HEALTH ADVANTAGE | OTHER | 00G527180 | 01 | CA | BLUE SHIELD | OTHER | 1452862 | 01 | CA | UNITED | OTHER | 000810342543 | 01 | CA | PHCS | OTHER | 00G234540 | 05 | CA | MEDICAID | G52718 | 01 | CA | BLUE CROSS | OTHER | 502583 | 01 | CA | HEALTH NET | OTHER | 4507481 | 01 | CA | AETNA | OTHER | 1061820 | 01 | CA | FIRST HEALTH | OTHER | 1089864 | 01 | CA | GREAT WEST | OTHER |