Provider Demographics
NPI:1699097741
Name:EDWARD CHAN MEDICAL GROUP LTD, LLP
Entity type:Organization
Organization Name:EDWARD CHAN MEDICAL GROUP LTD, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-271-2271
Mailing Address - Street 1:7737 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1807
Mailing Address - Country:US
Mailing Address - Phone:713-271-2271
Mailing Address - Fax:713-271-2274
Practice Address - Street 1:7737 SOUTHWEST FWY
Practice Address - Street 2:SUITE 850
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1807
Practice Address - Country:US
Practice Address - Phone:713-271-2271
Practice Address - Fax:713-271-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4905207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113548503Medicaid
TX113548503Medicaid