Healthcare Provider Details

I. General information

NPI: 1700040656
Provider Name (Legal Business Name): ROY CHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 N CHERRY ST
TULARE CA
93274-2251
US

IV. Provider business mailing address

1050 N CHERRY ST
TULARE CA
93274-2251
US

V. Phone/Fax

Practice location:
  • Phone: 559-684-8703
  • Fax:
Mailing address:
  • Phone: 559-684-8703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA117014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: