Provider Demographics
NPI:1962429753
Name:CHANN, HARCHARN S (MD)
Entity type:Individual
Prefix:
First Name:HARCHARN
Middle Name:S
Last Name:CHANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6089 N FIRST
Mailing Address - Street 2:#102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5444
Mailing Address - Country:US
Mailing Address - Phone:559-449-9100
Mailing Address - Fax:559-449-9440
Practice Address - Street 1:6089 N FIRST
Practice Address - Street 2:#102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5444
Practice Address - Country:US
Practice Address - Phone:559-449-9100
Practice Address - Fax:559-449-9440
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3975200207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
A37211Medicare UPIN
CAYYY49816YMedicare ID - Type Unspecified