Healthcare Provider Details

I. General information

NPI: 1770578874
Provider Name (Legal Business Name): SECK LAM CHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

728 PACIFIC AVENUE 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 Code208800000X
TaxonomyUrology Physician
License NumberC43212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: