Healthcare Provider Details

I. General information

NPI: 1912039850
Provider Name (Legal Business Name): LESLIE CHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8131 S MEMORIAL DR STE 100
TULSA OK
74133-4348
US

IV. Provider business mailing address

8131 S MEMORIAL DR STE 100
TULSA OK
74133-4348
US

V. Phone/Fax

Practice location:
  • Phone: 918-200-9944
  • Fax: 877-616-3089
Mailing address:
  • Phone: 918-200-9944
  • Fax: 877-616-3089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number32172
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number32172
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: