Healthcare Provider Details

I. General information

NPI: 1568994010
Provider Name (Legal Business Name): STEPHEN A CHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N ROSE AVE STE 460
OXNARD CA
93030-7629
US

IV. Provider business mailing address

1700 N ROSE AVE STE 460
OXNARD CA
93030-7629
US

V. Phone/Fax

Practice location:
  • Phone: 805-983-0395
  • Fax: 805-983-0463
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA178855
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: