Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | A43296 | CA |
NPI | 1053343434 |
---|---|
Provider Name | Dr. Dennis Y. Chan |
First Address | Alhambra, CA 91802-6427 |
Second Address | Monterey Park, CA 91754-1242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 03/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A432960 | BLUE SHIELD (01) | |
00A432961 | (05) | CA |
E89842 | (02) | CA |