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General NPI Number Information
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NPI Number | 1609225457
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Entity Type | Organization
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Legal Business Name | CANDY K CHAN, MD, PHD
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Dates
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Enumeration Date | 06/11/2016
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 709 FREMONT AVE SUITE C
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-2559
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Country | US
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Telephone | 323-459-3136
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Fax |
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Provider Business Mailing Address
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Address Line | 1144 S CHAPEL AVE
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City | ALHAMBRA
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State | CA
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Zip | 91801-4827
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Country | US
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Telephone | 323-459-3136
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CANDY K CHAN
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Credential | MD, PHD
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Telephone | 323-459-3136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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