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General NPI Number Information
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NPI Number | 1639105745
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Entity Type | Individual
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Provider Name | CONNIE CHAN D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 02/18/2008
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Provider Practice Location Address
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Address Line | 525 N GARFIELD AVE
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City | MONTEREY PARK
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State | CA
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Zip | 91754-1202
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Country | US
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Telephone | 626-307-2129
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Fax | 626-307-2056
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Provider Business Mailing Address
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Address Line | 2405 ROLLING GREEN DR
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City | SANTA MARIA
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State | CA
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Zip | 93455-1525
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Country | US
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Telephone | 805-928-5331
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Fax | 805-928-5331
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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 | 20A6654
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License Number State | CA
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