Provider Demographics
NPI:1285636787
Name:CHAN, CYNTHIA MARIA LEONG (PA)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:MARIA LEONG
Last Name:CHAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 S GARFIELD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3800
Mailing Address - Country:US
Mailing Address - Phone:626-289-7333
Mailing Address - Fax:626-289-6599
Practice Address - Street 1:333 S GARFIELD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3800
Practice Address - Country:US
Practice Address - Phone:626-289-7333
Practice Address - Fax:626-289-6599
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 15539363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA15539AMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
CAP59963Medicare UPIN