Healthcare Provider Details

I. General information

NPI: 1982809307
Provider Name (Legal Business Name): REBECCA CHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2007
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 IMPERIAL HWY
DOWNEY CA
90242-3456
US

IV. Provider business mailing address

7601 IMPERIAL HWY
DOWNEY CA
90242-3456
US

V. Phone/Fax

Practice location:
  • Phone: 562-385-7755
  • Fax:
Mailing address:
  • Phone: 562-385-7755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036-114954
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number244535
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0106549A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA114093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: