MEDICARE: DR. RANDALL YIMBONG 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	207R00000X	Internal Medicine Physician	A102847	CA
2	208000000X	Pediatrics Physician	A102847	CA
3	2080P0207X	Pediatric Hematology & Oncology Physician	A102847	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	:	1821269804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL YIMBONG CHAN M.D.

Provider Business Mailing Address
First Line	:	2020 ZONAL AVE # IRD124
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0121
Country	:	US
Telephone Number	:	323-226-3691
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 ZONAL AVE # IRD124
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0121
Country	:	US
Telephone Number	:	323-226-3691
Fax Number	:

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

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	04/03/2015

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