Healthcare Provider Details

I. General information

NPI: 1114987526
Provider Name (Legal Business Name): SAMUEL TO-HANG CHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 12/16/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 COYLE AVE # 301
CARMICHAEL CA
95608-6333
US

IV. Provider business mailing address

6620 COYLE AVE # 301
CARMICHAEL CA
95608-6333
US

V. Phone/Fax

Practice location:
  • Phone: 916-961-2514
  • Fax: 916-961-0297
Mailing address:
  • Phone: 916-961-2514
  • Fax: 916-961-0297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA61116
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA06116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: