Healthcare Provider Details

I. General information

NPI: 1932247855
Provider Name (Legal Business Name): JIM CHIYEUNG CHAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 S BALDWIN AVE
ARCADIA CA
91007-7235
US

IV. Provider business mailing address

1021 S BALDWIN AVE
ARCADIA CA
91007-7235
US

V. Phone/Fax

Practice location:
  • Phone: 626-821-9722
  • Fax:
Mailing address:
  • Phone: 626-821-9722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number9872T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: