Provider Demographics
NPI:1164655239
Name:CHAN, VERNON REGINALD (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:VERNON
Middle Name:REGINALD
Last Name:CHAN
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Gender:M
Credentials:MEDICAL DOCTOR
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Mailing Address - Street 1:17338 CITRONIA ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2013
Mailing Address - Country:US
Mailing Address - Phone:818-886-3300
Mailing Address - Fax:818-886-6300
Practice Address - Street 1:17338 CITRONIA ST
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-2013
Practice Address - Country:US
Practice Address - Phone:818-886-3300
Practice Address - Fax:818-886-6300
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2024-03-30
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Provider Licenses
StateLicense IDTaxonomies
CAA18421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine