MEDICARE: LINDA CHAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	A95324	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CK517W	OTHER		PTAN

General Provider Information

NPI Number	:	1083844427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA CHAN M.D.

Provider Business Mailing Address
First Line	:	24302 PASEO DE VALENCIA
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3115
Country	:	US
Telephone Number	:	949-452-8880
Fax Number	:	949-859-5980

Provider Business Practice Location Address
First Line	:	24302 PASEO DE VALENCIA
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3115
Country	:	US
Telephone Number	:	949-452-8880
Fax Number	:	949-859-5980

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2009
Last Update Date	:	07/31/2024

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