Healthcare Provider Details

I. General information

NPI: 1427314368
Provider Name (Legal Business Name): BARBARA JANE CHAN GANCHINGCO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 E SAN JACINTO AVE
PERRIS CA
92570-2878
US

IV. Provider business mailing address

308 E SAN JACINTO AVE
PERRIS CA
92570-2878
US

V. Phone/Fax

Practice location:
  • Phone: 951-940-6700
  • Fax: 951-940-6726
Mailing address:
  • Phone: 951-940-6700
  • Fax: 951-940-6726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A14212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: