Provider Demographics
NPI:1316576861
Name:CHAN, JUSTIN PRESCOTT (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:PRESCOTT
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 THE CITY DRIVE S
Mailing Address - Street 2:PAV. 3, 2ND FLOOR
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-456-7513
Mailing Address - Fax:714-456-8971
Practice Address - Street 1:101 THE CITY DRIVE S
Practice Address - Street 2:PAV. 3, 2ND FLOOR
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-456-7513
Practice Address - Fax:714-456-8971
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program