MEDICARE: DR. BRENDA M CHAN DNP, FNP, RN-BC

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	363L00000X	Nurse Practitioner	9505	CA

General Provider Information

NPI Number	:	1487135190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENDA M CHAN DNP, FNP, RN-BC

Provider Business Mailing Address
First Line	:	6816 SULTANA AVE
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91775-1527
Country	:	US
Telephone Number	:	626-236-8313
Fax Number	:

Provider Business Practice Location Address
First Line	:	6816 SULTANA AVE
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91775-1527
Country	:	US
Telephone Number	:	626-236-8313
Fax Number	:

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

Provider Enumeration Date	:	08/22/2018
Last Update Date	:	08/22/2018

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