Healthcare Provider Details

I. General information

NPI: 1508197625
Provider Name (Legal Business Name): LINDA CHAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

2650 ELM AVE #201
LONG BEACH CA
90806-1651
US

V. Phone/Fax

Practice location:
  • Phone: 562-492-6695
  • Fax: 562-988-0389
Mailing address:
  • Phone: 562-492-6695
  • Fax: 562-988-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA95324
License Number StateCA

VIII. Authorized Official

Name: LINDA W CHAN
Title or Position: OWNER
Credential: M.D
Phone: 562-492-6695