Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | C50269 | CA |
N | 207QA0505X | Family Doctor - Adult Medicine | 2330 | HI |
NPI | 1073681383 |
---|---|
Provider Name | Dr. Pablo Chua Chan |
First Address | Chula Vista, CA 91911 |
Second Address | Wainae, HAWAII 96792 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 15/10/2007 |