MEDICARE: DR. ANTONIO QUAN 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	207RC0000X	Cardiovascular Disease Physician	A35593	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669558508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTONIO QUAN CHAN M.D.

Provider Business Mailing Address
First Line	:	3726 LAS VEGAS BLVD S UNIT 3501W
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89158-4399
Country	:	US
Telephone Number	:	702-882-6740
Fax Number	:

Provider Business Practice Location Address
First Line	:	1289 S. PARK VICTORIA DRIVE
Second Line	:	SUITE 200
City	:	MILPITAS
State	:	CA
Zip	:	95035-6974
Country	:	US
Telephone Number	:	408-586-8866
Fax Number	:	408-586-8858

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	03/26/2020

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Directions to “ DR. ANTONIO QUAN CHAN M.D.” Practice Location

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