MEDICARE: LUKE K CHAN M.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	207Q00000X	Family Medicine Physician	A51050	CA

General Provider Information

NPI Number	:	1558374116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE K CHAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2128
Second Line	:
City	:	WALNUT
State	:	CA
Zip	:	91788-2128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 W VALLEY BLVD
Second Line	:	# C
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3728
Country	:	US
Telephone Number	:	626-943-9240
Fax Number	:

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	03/07/2023

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