MEDICARE: ADRIENNE CAROL MAR CHAN PA-C

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	363AM0700X	Medical Physician Assistant	PA53152	CA
2	363A00000X	Physician Assistant	53152	CA
3	183700000X	Pharmacy Technician	101049	CA

General Provider Information

NPI Number	:	1699134098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE CAROL MAR CHAN PA-C

Provider Business Mailing Address
First Line	:	PO BOX 31001-4303
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91110-0001
Country	:	US
Telephone Number	:	858-260-2977
Fax Number	:	858-332-1811

Provider Business Practice Location Address
First Line	:	1850 S AZUSA AVE STE 206
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-6853
Country	:	US
Telephone Number	:	626-810-5450
Fax Number	:	626-810-0391

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

Provider Enumeration Date	:	02/15/2016
Last Update Date	:	01/12/2026

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