Provider Demographics
NPI:1437256864
Name:CHAN, HUNG (MD)
Entity Type:Individual
Prefix:
First Name:HUNG
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 J ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3626
Mailing Address - Country:US
Mailing Address - Phone:916-453-4966
Mailing Address - Fax:916-739-1269
Practice Address - Street 1:3160 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5219
Practice Address - Country:US
Practice Address - Phone:916-733-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52718207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA90026118OtherPACIFICARE
CA4067OtherINTERPLAN
CA5635361OtherFIRST HEALTH
CAMCMG168300OtherWESTERN HEALTH ADVANTAGE
CA00G527180OtherBLUE SHIELD
CA1452862OtherUNITED
CA000810342543OtherPHCS
CA00G234540Medicaid
CAG52718OtherBLUE CROSS
CA502583OtherHEALTH NET
CA4507481OtherAETNA
CA1061820OtherFIRST HEALTH
CA1089864OtherGREAT WEST
CA502583OtherHEALTH NET
CA000810342543OtherPHCS