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General NPI Number Information
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NPI Number | 1225338007
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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 | 10/27/2010
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Last Update Date | 12/06/2013
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Provider Practice Location Address
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Address Line | 1289 S PARK VICTORIA DR
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City | MILPITAS
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State | CA
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Zip | 95035-6996
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Country | US
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Telephone | 408-586-8866
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Fax |
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Provider Business Mailing Address
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Address Line | 1289 S PARK VICTORIA DR
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City | MILPITAS
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State | CA
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Zip | 95035-6996
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Country | US
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Telephone | 408-586-8866
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. ESTRELLITA LUA CHAN
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Credential | M.D.
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Telephone | 408-586-8866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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