MEDICARE: EM & DA GROUP

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	207Q00000X	Family Medicine Physician	A40174	CA

General Provider Information

NPI Number	:	1811129976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EM & DA GROUP

Provider Business Mailing Address
First Line	:	501 W GLENOAKS BLVD # 23
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2896
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2440 MARIPOSA ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-1423
Country	:	US
Telephone Number	:	415-271-8862
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CONSTANT CHAN
Credential	:
Telephone Number	:	415-271-8862

Provider Enumeration Date	:	08/21/2009
Last Update Date	:	08/21/2009

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