MEDICARE: DR. PERRY CHAN PH.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	207SG0203X	Clinical Molecular Genetics Physician	CHANS5	NY

General Provider Information

NPI Number	:	1760454581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PERRY CHAN PH.D.

Provider Business Mailing Address
First Line	:	20606 CLARK ST
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-6823
Country	:	US
Telephone Number	:	818-348-2547
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 LOST HILLS RD
Second Line	:
City	:	CALABASAS HILLS
State	:	CA
Zip	:	91301-5358
Country	:	US
Telephone Number	:	818-880-8040
Fax Number	:

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	07/08/2007

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