Provider Demographics
NPI:1083612626
Name:CHAN, ESMOND KA-WAI (MD)
Entity Type:Individual
Prefix:
First Name:ESMOND
Middle Name:KA-WAI
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:DEPT 9697
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-9697
Mailing Address - Country:US
Mailing Address - Phone:949-721-6520
Mailing Address - Fax:949-721-6120
Practice Address - Street 1:1069 LOS PALOS DR
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901
Practice Address - Country:US
Practice Address - Phone:831-758-2724
Practice Address - Fax:831-758-1531
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG383292085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G383290Medicaid
00G383291Medicare PIN