Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | G79829 | CA |
NPI | 1003818501 |
---|---|
Provider Name | Dr. Justin Le Chan |
First Address | Alhambra, CA 91801-3800 |
Second Address | Alhambra, CA 91801-4442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G798290 | (05) | CA |
G75693 | (02) | CA |