Provider Demographics
NPI:1568486926
Name:CHAN, ALLEN K (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:K
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:29910 MURRIETA HOT SPRINGS ROAD
Mailing Address - Street 2:SUITE G345
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3814
Mailing Address - Country:US
Mailing Address - Phone:951-566-9370
Mailing Address - Fax:951-200-4401
Practice Address - Street 1:28078 BAXTER RD STE 420
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-1404
Practice Address - Country:US
Practice Address - Phone:760-969-2900
Practice Address - Fax:858-712-1234
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG863221208600000X
CAG863222086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G863220Medicaid
CA00G8632210Medicare ID - Type Unspecified
CA00G863220Medicaid
P00420170Medicare PIN
CAWA86322AMedicare PIN