Healthcare Provider Details

I. General information

NPI: 1760454581
Provider Name (Legal Business Name): PERRY CHAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 LOST HILLS RD
CALABASAS HILLS CA
91301-5358
US

IV. Provider business mailing address

20606 CLARK ST
WOODLAND HILLS CA
91367-6823
US

V. Phone/Fax

Practice location:
  • Phone: 818-880-8040
  • Fax:
Mailing address:
  • Phone: 818-348-2547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License NumberCHANS5
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: