MEDICARE: SUSAN CHAN

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	225100000X	Physical Therapist	PT23164	CA

General Provider Information

NPI Number	:	1699862987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN CHAN

Provider Business Mailing Address
First Line	:	3571 N 1ST ST STE 200
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95134-2405
Country	:	US
Telephone Number	:	408-424-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3571 N 1ST ST STE 200
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95134-2405
Country	:	US
Telephone Number	:	408-424-2000
Fax Number	:

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	09/20/2022

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Directions to “ SUSAN CHAN ” Practice Location

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