Healthcare Provider Details

I. General information

NPI: 1215863071
Provider Name (Legal Business Name): PATRICK CHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6826 S CENTINELA AVE
CULVER CITY CA
90230-6301
US

IV. Provider business mailing address

1955 RADCLAY DR
WALNUT CA
91789-3531
US

V. Phone/Fax

Practice location:
  • Phone: 310-915-0100
  • Fax:
Mailing address:
  • Phone: 626-267-8510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT310041
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: