Provider Demographics
NPI:1285758813
Name:CHAN, ALAN BRIAN (OD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:BRIAN
Last Name:CHAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 KEARNY ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-1303
Mailing Address - Country:US
Mailing Address - Phone:415-397-5295
Mailing Address - Fax:415-296-7866
Practice Address - Street 1:827 KEARNY ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1303
Practice Address - Country:US
Practice Address - Phone:415-397-5295
Practice Address - Fax:415-296-7866
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5805152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0058050Medicaid