MEDICARE: JASON EARL CHAN M.D. PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	25MA10929100	NJ
2	207RH0003X	Hematology & Oncology Physician	283501	NY
3	207RH0003X	Hematology & Oncology Physician	C206204	CA

General Provider Information

NPI Number	:	1154735660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON EARL CHAN M.D. PH.D.

Provider Business Mailing Address
First Line	:	127 S SAN VICENTE BLVD FL 7
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-3311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 S SAN VICENTE BLVD FL 7
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-3311
Country	:	US
Telephone Number	:	310-423-8530
Fax Number	:	310-423-4759

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2014
Last Update Date	:	03/03/2026

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