Provider Demographics
NPI:1609225457
Name:CANDY K CHAN, MD, PHD
Entity Type:Organization
Organization Name:CANDY K CHAN, MD, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:323-459-3136
Mailing Address - Street 1:1144 S CHAPEL AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4827
Mailing Address - Country:US
Mailing Address - Phone:323-459-3136
Mailing Address - Fax:
Practice Address - Street 1:709 FREMONT AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2559
Practice Address - Country:US
Practice Address - Phone:323-459-3136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-11
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty