Provider Demographics
NPI:1285767798
Name:PHILIP T C CHAN MD INC
Entity type:Organization
Organization Name:PHILIP T C CHAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:T C
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-284-7300
Mailing Address - Street 1:821 S GARFIELD AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5839
Mailing Address - Country:US
Mailing Address - Phone:626-284-7300
Mailing Address - Fax:
Practice Address - Street 1:821 S GARFIELD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5839
Practice Address - Country:US
Practice Address - Phone:626-284-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2007-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39596207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W14129Medicare PIN