MEDICARE: MR. JOHNNY PINGHON 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	183500000X	Pharmacist	RPH32261	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHY11062	OTHER	CA	PHARMACY LICENCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881687846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHNNY PINGHON CHAN

Provider Business Mailing Address
First Line	:	3137 JEFFERSON AVE
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94062-2959
Country	:	US
Telephone Number	:	650-366-3784
Fax Number	:	650-366-1848

Provider Business Practice Location Address
First Line	:	3137 JEFFERSON AVE
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94062-2959
Country	:	US
Telephone Number	:	650-366-3784
Fax Number	:	650-366-1848

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	02/13/2008

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