Healthcare Provider Details

I. General information

NPI: 1639289614
Provider Name (Legal Business Name): FREDDY CHAN P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2063 S ATLANTIC BLVD SUITE 300
MONTEREY PARK CA
91754-6344
US

IV. Provider business mailing address

5451 LA PALMA AVE SUITE 25
LA PALMA CA
90623-1730
US

V. Phone/Fax

Practice location:
  • Phone: 323-796-0170
  • Fax: 323-796-0220
Mailing address:
  • Phone: 714-670-1340
  • Fax: 714-443-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17266
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA17266
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA17266
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberPA17266
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberPA17266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: