Provider Demographics
NPI:1588763585
Name:CHAN, KIMBERLEY HOANG (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:HOANG
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:LE
Other - Last Name:HOANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5100 W GOLDLEAF CIR FL 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-1658
Mailing Address - Country:US
Mailing Address - Phone:323-293-7171
Mailing Address - Fax:
Practice Address - Street 1:5100 W GOLDLEAF CIR FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90056-1658
Practice Address - Country:US
Practice Address - Phone:323-293-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90277207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine