Provider Demographics
NPI:1336131408
Name:CHAN, CLEMENT K (MD)
Entity Type:Individual
Prefix:
First Name:CLEMENT
Middle Name:K
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:36949 COOK ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6080
Mailing Address - Country:US
Mailing Address - Phone:760-340-2394
Mailing Address - Fax:760-340-2369
Practice Address - Street 1:36949 COOK ST STE 101
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6080
Practice Address - Country:US
Practice Address - Phone:760-340-2394
Practice Address - Fax:760-340-2369
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG45036207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G450360Medicaid
CAA49854Medicare UPIN
CA00G450360Medicare PIN