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General NPI Number Information
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NPI Number | 1104470384
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Entity Type | Organization
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Legal Business Name | CHAN FAMILY MEDICAL CORP
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Dates
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Enumeration Date | 07/26/2019
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Last Update Date | 07/26/2019
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Provider Practice Location Address
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Address Line | 4070 E. OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90023
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Country | US
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Telephone | 323-685-2070
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Fax | 323-685-2077
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Provider Business Mailing Address
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Address Line | 4070 E. OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90023
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Country | US
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Telephone | 323-685-2070
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Fax | 323-685-2077
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | EMMELINE CHAN
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Credential | M.D
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Telephone | 323-685-2070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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