Basic Information
| Provider Information | |||||||||
| NPI: | 1528522257 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAN | ||||||||
| FirstName: | JEFFERY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6044 SULTANA AVE | ||||||||
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| City: | TEMPLE CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917801549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265921992 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 W HUNTINGTON DR | ||||||||
| Address2: | |||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910073402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268988000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2019 | ||||||||
| LastUpdateDate: | 01/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 16436 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.