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General NPI Number Information
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NPI Number | 1821403072
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Entity Type | Organization
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Legal Business Name | STACY CHAN MD INC
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Dates
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Enumeration Date | 06/26/2014
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Last Update Date | 06/26/2014
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Provider Practice Location Address
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Address Line | 8700 BEVERLY BLVD
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90048-1804
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Country | US
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Telephone | 510-709-6256
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Fax |
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Provider Business Mailing Address
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Address Line | 858 S BEDFORD ST UNIT 201
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City | LOS ANGELES
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State | CA
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Zip | 90035-1893
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Country | US
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Telephone | 510-709-6256
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STACY S CHAN
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Credential | MD
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Telephone | 510-709-6256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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