Healthcare Provider Details

I. General information

NPI: 1154735660
Provider Name (Legal Business Name): JASON EARL CHAN M.D. PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 S SAN VICENTE BLVD FL 7
LOS ANGELES CA
90048-3311
US

IV. Provider business mailing address

127 S SAN VICENTE BLVD FL 7
LOS ANGELES CA
90048-3311
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-8530
  • Fax: 310-423-4759
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number25MA10929100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number283501
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberC206204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: