Healthcare Provider Details

I. General information

NPI: 1063435147
Provider Name (Legal Business Name): CHARLIE K LAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 HOLCOMBE BLVD 3C-383
HOUSTON TX
77030-4211
US

IV. Provider business mailing address

3749 DRUMMOND ST
HOUSTON TX
77025-2417
US

V. Phone/Fax

Practice location:
  • Phone: 713-794-7961
  • Fax: 713-794-7316
Mailing address:
  • Phone: 832-277-3949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberL0362
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberL0362
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberL0362
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: