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General NPI Number Information
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NPI Number | 1124385976
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Entity Type | Organization
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Legal Business Name | CHANWELL MEDICAL GROUP NEVADA INC
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 2749 SUNRIDGE HEIGHTS PKWY
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City | HENDERSON
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State | NV
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Zip | 89052-5044
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Country | US
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Telephone | 702-568-0686
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Fax | 702-568-0687
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Provider Business Mailing Address
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Address Line | 3726 LAS VEGAS BLVD S UNIT 3501W
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City | LAS VEGAS
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State | NV
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Zip | 89158-4399
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Country | US
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Telephone | 408-828-2283
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANTHONY QUAN CHAN
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Credential | M.D
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Telephone | 702-568-0686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number | 042535
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 042535
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | A35593
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 42535
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License Number State | CA
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