Provider Demographics
NPI:1598784878
Name:SECK L. CHAN M.D., INC.
Entity Type:Organization
Organization Name:SECK L. CHAN M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SECK
Authorized Official - Middle Name:LAM
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-202-0260
Mailing Address - Street 1:728 PACIFIC AVE
Mailing Address - Street 2:SUITE 608
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4449
Mailing Address - Country:US
Mailing Address - Phone:415-202-0260
Mailing Address - Fax:415-202-0265
Practice Address - Street 1:728 PACIFIC AVE
Practice Address - Street 2:SUITE 608
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4449
Practice Address - Country:US
Practice Address - Phone:415-202-0260
Practice Address - Fax:415-202-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC43212174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACH021AOtherPTAN
CA1598784878Medicaid