Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath | 9007 | NV |
Y | 207Q00000X | Family Doctor | A48504 | CA |
NPI | 1417059957 |
---|---|
Provider Name | Bryan P Chan |
First Address | Upland, CA 91786-4943 |
Second Address | Upland, CA 91786-4943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2006 |
Last Update Date | 20/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A485040 | (05) | CA |
F46113 | (02) | CA |