Provider Demographics
NPI:1225347438
Name:CONSTANT K.S. CHAN M.D. INC.
Entity Type:Organization
Organization Name:CONSTANT K.S. CHAN M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANT
Authorized Official - Middle Name:KS
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-566-3157
Mailing Address - Street 1:10007 STATE ST
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-1514
Mailing Address - Country:US
Mailing Address - Phone:323-566-3157
Mailing Address - Fax:323-566-2676
Practice Address - Street 1:10007 STATE ST
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-1514
Practice Address - Country:US
Practice Address - Phone:323-566-3157
Practice Address - Fax:323-566-2676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40174261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A401740Medicaid
CAA85400Medicare UPIN
CAA40174Medicare PIN