Provider Demographics
NPI:1174681134
Name:CHAN, PHILIP TC (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:TC
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:821 S GARFIELD AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5839
Mailing Address - Country:US
Mailing Address - Phone:626-284-7300
Mailing Address - Fax:626-284-7374
Practice Address - Street 1:821 S GARFIELD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5839
Practice Address - Country:US
Practice Address - Phone:626-284-7300
Practice Address - Fax:626-284-7374
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39596207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G395961Medicaid
CA00G395960Medicaid
A92102Medicare UPIN
CA00G395960Medicaid