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General NPI Number Information
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NPI Number | 1255652384
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Entity Type | Organization
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Legal Business Name | KOK H CHAN MD INC
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 06/11/2010
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Provider Practice Location Address
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Address Line | 210 W SAN BERNARDINO RD
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City | COVINA
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State | CA
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Zip | 91723-1515
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Country | US
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Telephone | 626-331-7331
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Fax | 626-858-9584
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Provider Business Mailing Address
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Address Line | 5 HOLLAND STE 101
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City | IRVINE
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State | CA
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Zip | 92618-2568
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Country | US
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Telephone | 949-588-2190
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Fax | 949-588-2199
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Authorized Official
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Title or Position | PRESIDENT
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Name | KOK H CHAN
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Credential | MD
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Telephone | 949-588-2190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | A31474
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License Number State | CA
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