Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 54201 | CO |
Y | 207K00000X | Allergist & Immunologist | A108449 | CA |
N | 208000000X | Pediatrician | 54201 | CO |
N | 208000000X | Pediatrician | A108449 | CA |
NPI | 1043449788 |
---|---|
Provider Name | Dr. Sanny K Chan |
First Address | Santa Monica, CA 90404-2080 |
Second Address | Santa Monica, CA 90404-2080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2009 |
Last Update Date | 17/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
333357366 | (05) | CO |