MEDICARE: DR. WESLEY CHAN MD

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	2085R0202X	Diagnostic Radiology Physician	A117512	CA

General Provider Information

NPI Number	:	1538447883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WESLEY CHAN MD

Provider Business Mailing Address
First Line	:	3135 PACIFIC AVE
Second Line	:	APT #3
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-1033
Country	:	US
Telephone Number	:	415-734-0635
Fax Number	:

Provider Business Practice Location Address
First Line	:	3135 PACIFIC AVE
Second Line	:	APT #3
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-1033
Country	:	US
Telephone Number	:	415-734-0635
Fax Number	:

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

Provider Enumeration Date	:	08/03/2011
Last Update Date	:	08/03/2011

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