Healthcare Provider Details

I. General information

NPI: 1548778913
Provider Name (Legal Business Name): NINA CHAN, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 E FOOTHILL BLVD STE 104
UPLAND CA
91786-4068
US

IV. Provider business mailing address

980 E FOOTHILL BLVD STE 104
UPLAND CA
91786-4068
US

V. Phone/Fax

Practice location:
  • Phone: 909-920-3578
  • Fax:
Mailing address:
  • Phone: 909-920-3578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NINA CHAN
Title or Position: OWNER
Credential: MD
Phone: 909-920-3578