1699702324 NPI number — DR. GARY LEE CHAN M.D.

Table of content: DR. GARY LEE CHAN M.D. (NPI 1699702324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699702324 NPI number — DR. GARY LEE CHAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAN
Provider First Name:
GARY
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHAN
Provider Other First Name:
GARY
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1699702324
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909 HYDE ST
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94109-4822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-474-7900
Provider Business Mailing Address Fax Number:
415-474-7930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909 HYDE ST
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94109-4822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-474-7900
Provider Business Practice Location Address Fax Number:
415-474-7930
Provider Enumeration Date:
06/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  G34576 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)