Healthcare Provider Details

I. General information

NPI: 1033536917
Provider Name (Legal Business Name): JASON CHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 04/07/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DIVISADERO STREET UCSF MEDICAL CENTER
SAN FRANCISCO CA
94115-3358
US

IV. Provider business mailing address

1600 DIVISADERO STREET UCSF MEDICAL CENTER
SAN FRANCISCO CA
94115-3358
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7175
  • Fax: 415-353-9884
Mailing address:
  • Phone: 415-353-7175
  • Fax: 415-353-9884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA140034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: