1801109624 NPI number — WILLIAM HENRY CHAN M D PROFESSIONAL CORP.

Table of content: (NPI 1801109624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801109624 NPI number — WILLIAM HENRY CHAN M D PROFESSIONAL CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM HENRY CHAN M D PROFESSIONAL CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801109624
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5525 ASSEMBLY CT
Provider Second Line Business Mailing Address:
BLDG. C
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95823-2634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-421-1772
Provider Business Mailing Address Fax Number:
916-421-0635

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5525 ASSEMBLY CT
Provider Second Line Business Practice Location Address:
BLDG C
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95823-2634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-421-1772
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CHAN
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
HENRY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
916-421-1772

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A20775 , 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)

  • Identifier: 00A207750 . This is a "PTAN" identifier . This identifiers is of the category "OTHER".




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