Healthcare Provider Details

I. General information

NPI: 1699134098
Provider Name (Legal Business Name): ADRIENNE CAROL MAR CHAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 S AZUSA AVE STE 206
HACIENDA HEIGHTS CA
91745-6853
US

IV. Provider business mailing address

PO BOX 31001-4303
PASADENA CA
91110-0001
US

V. Phone/Fax

Practice location:
  • Phone: 626-810-5450
  • Fax: 626-810-0391
Mailing address:
  • Phone: 858-260-2977
  • Fax: 858-332-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number101049
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA53152
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA53152
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: