Healthcare Provider Details

I. General information

NPI: 1902716293
Provider Name (Legal Business Name): ANTHONY CHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 DAYTON RD
REDDING CT
06896-2903
US

IV. Provider business mailing address

50 WASHINGTON ST STE 7E-121
NORWALK CT
06854-2710
US

V. Phone/Fax

Practice location:
  • Phone: 475-242-8686
  • Fax:
Mailing address:
  • Phone: 475-242-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberHCA.0002948
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: