Healthcare Provider Details

I. General information

NPI: 1285070235
Provider Name (Legal Business Name): ANTHONY CHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20101 LAKE CHABOT RD
CASTRO VALLEY CA
94546-5305
US

IV. Provider business mailing address

2345 COUNTRY HILLS DR # 100
ANTIOCH CA
94509-7319
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-8168
  • Fax: 510-506-7729
Mailing address:
  • Phone: 925-418-0282
  • Fax: 925-978-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA156682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: