Healthcare Provider Details

I. General information

NPI: 1366425548
Provider Name (Legal Business Name): EDWARD I. CHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2433 CENTRAL AVE STE A
ALAMEDA CA
94501-6562
US

IV. Provider business mailing address

2433 CENTRAL AVE STE A
ALAMEDA CA
94501-6562
US

V. Phone/Fax

Practice location:
  • Phone: 510-521-2300
  • Fax: 510-521-7947
Mailing address:
  • Phone: 510-521-2300
  • Fax: 510-521-7947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA74119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: