Provider Demographics
NPI:1003818501
Name:CHAN, JUSTIN LE (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:LE
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:333 S GARFIELD AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3800
Mailing Address - Country:US
Mailing Address - Phone:626-282-8046
Mailing Address - Fax:626-289-6599
Practice Address - Street 1:925 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4442
Practice Address - Country:US
Practice Address - Phone:626-282-0282
Practice Address - Fax:626-282-0939
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG79829207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G798290Medicaid
CAWG79829AMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
CA00G798290Medicaid