Basic Information
| Provider Information | |||||||||
| NPI: | 1831849405 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAN | ||||||||
| FirstName: | ANTHONY | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6240 RIDGEMONT DR | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946193725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102827971 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11500 BROOKSHIRE AVE OFC DOWNEY | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902414917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629045000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2022 | ||||||||
| LastUpdateDate: | 03/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.