Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A35065 | CA |
N | 111NI0900X | Internist | A35065 | CA |
N | 208D00000X | General Practice Physician | A35065 | CA |
NPI | 1023049707 |
---|---|
Provider Name | Mr. Pak Chun Chan |
First Address | Lockeford, CA 95237 |
Second Address | Lockford, CA 95237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A350651 | (05) | CA |
A88320 | (02) |