Healthcare Provider Details

I. General information

NPI: 1154522340
Provider Name (Legal Business Name): GRACE CHAN OEI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LLUMC HOUSE STAFF OFFICE CP 21005, 11234 ANDERSON STREET
LOMA LINDA CA
92354-2741
US

IV. Provider business mailing address

LOMA LINDA UNIVERSITY FACULTY MEDICAL GROUP 11175 CAMPUS STREET
LOMA LINDA CA
92350
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4000
  • Fax:
Mailing address:
  • Phone: 909-558-4250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA94619
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA94619
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA94619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: