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General NPI Number Information
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NPI Number | 1336235811
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Entity Type | Individual
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Provider Name | IAN CHAN MD
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 10565 HOSPITAL WAY, BLDG 647 CARDIOLOGY DEPARTMENT
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City | MATHER
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State | CA
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Zip | 95655
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Country | US
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Telephone | 916-366-5391
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Fax |
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Provider Business Mailing Address
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Address Line | 10565 HOSPITAL WAY, BLDG 647 CARDIOLOGY DEPARTMENT
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City | MATHER
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State | CA
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Zip | 95655
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Country | US
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Telephone | 916-366-5391
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MD045837L
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License Number State | PA
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