Provider Demographics
NPI:1043256720
Name:CHAN, JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:CHAN
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 1:2125 OAK GROVE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2536
Mailing Address - Country:US
Mailing Address - Phone:925-296-7150
Mailing Address - Fax:925-296-7171
Practice Address - Street 1:2125 OAK GROVE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2536
Practice Address - Country:US
Practice Address - Phone:925-296-7150
Practice Address - Fax:925-296-7171
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC391222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C391225Medicare PIN
CA300104835Medicare PIN
CA00C391222Medicare PIN
CA00C3912220Medicare PIN
CA00C391224Medicare PIN
CA00C3912216Medicare PIN
CA00C391226Medicare PIN
CA00C391221Medicare PIN
CAA37067Medicare UPIN
CA00C3912210Medicare PIN
CA00C391229Medicare PIN
CA00C391220Medicare PIN
CA00C3912212Medicare PIN
CA00C3912217Medicare PIN
CA00C3912218Medicare PIN
CA300106004Medicare PIN
CA00C3912215Medicare PIN
CA00C391223Medicare PIN
CA00C391227Medicare PIN
CA300105950Medicare PIN
CA00C3912211Medicare PIN
CA00C3912214Medicare PIN
CA00C3912219Medicare PIN
CA00C391228Medicare PIN
CA00C3912213Medicare PIN