Provider Demographics
NPI:1427622919
Name:CHAN, CASSIE
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 HUNTINGTON DR STE 10
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2655
Mailing Address - Country:US
Mailing Address - Phone:626-796-0821
Mailing Address - Fax:626-463-1420
Practice Address - Street 1:2233 HUNTINGTON DR STE 10
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2655
Practice Address - Country:US
Practice Address - Phone:626-796-0821
Practice Address - Fax:626-463-1420
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA63263363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant