Healthcare Provider Details

I. General information

NPI: 1912698838
Provider Name (Legal Business Name): STEPHANIE CHAN, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 07/05/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 W 6TH ST STE 411
LOS ANGELES CA
90020-5112
US

IV. Provider business mailing address

21143 HAWTHORNE BLVD # 251
TORRANCE CA
90503-4615
US

V. Phone/Fax

Practice location:
  • Phone: 424-587-0863
  • Fax:
Mailing address:
  • Phone: 424-587-0863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. STEPHANIE CHAN
Title or Position: FOUNDER
Credential: MD
Phone: 310-963-9699