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General NPI Number Information
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NPI Number | 1881872661
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Entity Type | Organization
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Legal Business Name | ROGER CHAN MD A MEDICAL CORP.
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 8150 GARVEY AVE SUITE 103A
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City | ROSEMEAD
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State | CA
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Zip | 91770-2472
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Country | US
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Telephone | 626-288-8759
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Fax | 626-573-8597
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Provider Business Mailing Address
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Address Line | PO BOX 2113
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City | ROSEMEAD
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State | CA
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Zip | 91770-7213
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Country | US
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Telephone | 626-288-8759
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Fax | 626-573-8597
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROGER C. CHAN
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Credential | M.D.
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Telephone | 626-288-8759
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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 | G73468
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License Number State | CA
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