Provider Demographics
NPI:1497068688
Name:CHAN, DAVID DEGUIRE (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DEGUIRE
Last Name:CHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10840 WARNER AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3847
Mailing Address - Country:US
Mailing Address - Phone:714-395-4595
Mailing Address - Fax:
Practice Address - Street 1:10840 WARNER AVE STE 103
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3847
Practice Address - Country:US
Practice Address - Phone:714-395-4595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13372207R00000X, 208M00000X
IL125057749207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A13372Medicaid