Healthcare Provider Details

I. General information

NPI: 1487660833
Provider Name (Legal Business Name): MICHAEL Y CHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W LA VETA AVE STE 430
ORANGE CA
92868
US

IV. Provider business mailing address

1140 W LA VETA AVE STE 430
ORANGE CA
92868-4226
US

V. Phone/Fax

Practice location:
  • Phone: 714-543-5555
  • Fax: 714-836-2427
Mailing address:
  • Phone: 714-543-5555
  • Fax: 714-836-2427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA73775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: