Healthcare Provider Details

I. General information

NPI: 1467413666
Provider Name (Legal Business Name): ALEXANDER THUYA CHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 S RAYMOND AVE 200
ALHAMBRA CA
91801-7100
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 626-293-1350
  • Fax: 626-570-5638
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA050708
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: