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NPI Code Detail

MEDICARE: DR. SAMUEL CHAN M.D.

MEDICARE: DR. SAMUEL 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
1207Q00000XFamily Medicine PhysicianG26972CA

General Provider Information

NPI Number : 1841371200
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SAMUEL CHAN M.D.
Provider Business Mailing Address
First Line : 13091 KERRY ST
Second Line :
City : GARDEN GROVE
State : CA
Zip : 92844-1638
Country : US
Telephone Number : 714-638-8811
Fax Number : 714-638-2799
Provider Business Practice Location Address
First Line : 13091 KERRY ST
Second Line :
City : GARDEN GROVE
State : CA
Zip : 92844-1638
Country : US
Telephone Number : 714-638-8811
Fax Number : 714-638-2799
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2006
Last Update Date : 08/13/2015

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