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General NPI Number Information
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NPI Number | 1194747147
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Entity Type | Organization
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Legal Business Name | CHANWELL MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 2690 SOUTH WHITE ROAD SUITE 10
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City | SAN JOSE
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State | CA
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Zip | 95148-2075
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Country | US
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Telephone | 408-270-8668
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Fax | 408-270-8669
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Provider Business Mailing Address
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Address Line | 1715 LUNDY AVE SUITE 174
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City | SAN JOSE
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State | CA
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Zip | 95131-1837
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Country | US
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Telephone | 408-436-5588
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Fax | 408-436-5487
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. ESTRELLITA L CHAN
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Credential | M.D.
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Telephone | 408-270-8668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A35593
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License Number State | CA
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