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General NPI Number Information
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NPI Number | 1568791994
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Entity Type | Individual
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Provider Name | ADDISON CHAN
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Gender | Male
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Dates
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Enumeration Date | 12/14/2009
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 1700 COFFEE RD EMERGENCY DEPARTMENT
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City | MODESTO
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State | CA
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Zip | 95355-2803
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Country | US
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Telephone | 209-526-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 4012 WILD POPPY CT
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City | MODESTO
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State | CA
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Zip | 95356-8793
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Country | US
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Telephone | 831-239-8371
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | R7410
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 20A11051
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | OS022272
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License Number State | PA
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