Provider Demographics
NPI:1326105743
Name:CHAN, CHARLES CHIUSUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CHIUSUNG
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 1:500 N GARFIELD AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1242
Mailing Address - Country:US
Mailing Address - Phone:626-288-8590
Mailing Address - Fax:626-288-8616
Practice Address - Street 1:500 N GARFIELD AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1242
Practice Address - Country:US
Practice Address - Phone:626-288-8590
Practice Address - Fax:626-288-8616
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29783207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29783Medicare ID - Type Unspecified
CAD76445Medicare UPIN