Healthcare Provider Details

I. General information

NPI: 1265498505
Provider Name (Legal Business Name): DANIEL K CHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 W SANTA ANITA ST STE B
SAN GABRIEL CA
91776
US

IV. Provider business mailing address

1014 S MARENGO AVE #6
ALHAMBRA CA
91803
US

V. Phone/Fax

Practice location:
  • Phone: 626-576-1755
  • Fax: 626-576-1755
Mailing address:
  • Phone: 626-282-0686
  • Fax: 626-282-0686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA86714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: