Healthcare Provider Details

I. General information

NPI: 1366515744
Provider Name (Legal Business Name): ALLEN K. CHAN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 E VALLEY PKWY SUITE 404
ESCONDIDO CA
92025-3363
US

IV. Provider business mailing address

PO BOX 460995
ESCONDIDO CA
92046-0995
US

V. Phone/Fax

Practice location:
  • Phone: 760-743-3912
  • Fax: 760-739-7633
Mailing address:
  • Phone: 760-743-3912
  • Fax: 760-739-7633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG86322
License Number StateCA

VIII. Authorized Official

Name: ALLEN CHAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-743-3912