Provider Demographics
NPI:1265498505
Name:CHAM, DANIEL K (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:K
Last Name:CHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1014 S MARENGO AVE
Mailing Address - Street 2:#6
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803
Mailing Address - Country:US
Mailing Address - Phone:626-282-0686
Mailing Address - Fax:626-282-0686
Practice Address - Street 1:714 W SANTA ANITA ST
Practice Address - Street 2:STE B
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776
Practice Address - Country:US
Practice Address - Phone:626-576-1755
Practice Address - Fax:626-576-1755
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA86714208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA86714AMedicare ID - Type Unspecified
I06760Medicare UPIN