Provider Demographics
NPI:1053644021
Name:ERIC S.P. CHAN, M.D., INC.
Entity Type:Organization
Organization Name:ERIC S.P. CHAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SIU PING
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-927-0874
Mailing Address - Street 1:600 N GARFIELD AVE
Mailing Address - Street 2:312
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1171
Mailing Address - Country:US
Mailing Address - Phone:626-927-0874
Mailing Address - Fax:626-927-0875
Practice Address - Street 1:600 N GARFIELD AVE
Practice Address - Street 2:312
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1171
Practice Address - Country:US
Practice Address - Phone:626-927-0874
Practice Address - Fax:626-927-0875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51580207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A515800OtherMEDI-CAL LICENSE NUMBER
CAA51580Medicare Oscar/Certification
CAF92460Medicare UPIN