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General NPI Number Information
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NPI Number | 1083802599
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Entity Type | Individual
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Provider Name | MELINDA CHAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 03/25/2013
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Provider Practice Location Address
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Address Line | 8929 WILSHIRE BLVD PH SUITE 500
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-1938
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Country | US
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Telephone | 424-256-5272
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Fax |
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Provider Business Mailing Address
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Address Line | 11740 WILSHIRE BLVD A1809
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City | LOS ANGELES
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State | CA
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Zip | 90025-6536
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Country | US
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Telephone | 424-256-5272
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | PA18187
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA18187
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License Number State | CA
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