Healthcare Provider Details

I. General information

NPI: 1235768268
Provider Name (Legal Business Name): DONALD CHUN LAI CHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 MAPLE ST
REDWOOD CITY CA
94063-2057
US

IV. Provider business mailing address

905 MAPLE ST
REDWOOD CITY CA
94063-2057
US

V. Phone/Fax

Practice location:
  • Phone: 650-299-3930
  • Fax:
Mailing address:
  • Phone: 650-299-3930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA188695
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: