Provider Demographics
NPI:1467413666
Name:CHAN, ALEXANDER THUYA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:THUYA
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:37 W WINNIE WAY
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-8048
Mailing Address - Country:US
Mailing Address - Phone:626-294-0028
Mailing Address - Fax:626-570-5638
Practice Address - Street 1:55 S RAYMOND AVE
Practice Address - Street 2:200
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-7100
Practice Address - Country:US
Practice Address - Phone:626-293-1350
Practice Address - Fax:626-570-5638
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA050708207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
22277306ZMedicare ID - Type Unspecified
CAF49824Medicare UPIN