Healthcare Provider Details

I. General information

NPI: 1598784878
Provider Name (Legal Business Name): SECK L. CHAN M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 PACIFIC AVE SUITE 608
SAN FRANCISCO CA
94133-4449
US

IV. Provider business mailing address

728 PACIFIC AVE SUITE 608
SAN FRANCISCO CA
94133-4449
US

V. Phone/Fax

Practice location:
  • Phone: 415-202-0260
  • Fax: 415-202-0265
Mailing address:
  • Phone: 415-202-0260
  • Fax: 415-202-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC43212
License Number StateCA

VIII. Authorized Official

Name: DR. SECK LAM CHAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 415-202-0260